Provider Demographics
NPI:1134640071
Name:WAL MART STORES TEXAS LLC
Entity Type:Organization
Organization Name:WAL MART STORES TEXAS LLC
Other - Org Name:WALMART VISION CENTER 30-2463
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR HEALTHCARE CONTRACTING
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-277-2500
Mailing Address - Street 1:702 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72716-0445
Mailing Address - Country:US
Mailing Address - Phone:479-277-2500
Mailing Address - Fax:
Practice Address - Street 1:355 STONEBROOK PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-987-8768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAL-MART SORES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-30
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty