Provider Demographics
NPI:1083738835
Name:WALMAN OPTICAL COMPANY
Entity Type:Organization
Organization Name:WALMAN OPTICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-520-6000
Mailing Address - Street 1:1404 33RD STREET SOUTH
Mailing Address - Street 2:SUITE K
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103
Mailing Address - Country:US
Mailing Address - Phone:701-235-0571
Mailing Address - Fax:800-955-3053
Practice Address - Street 1:1404 33RD ST S
Practice Address - Street 2:SUITE K
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3482
Practice Address - Country:US
Practice Address - Phone:701-235-0571
Practice Address - Fax:800-955-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND59112Medicaid