Provider Demographics
NPI:1154457679
Name:WALMART #1822
Entity Type:Organization
Organization Name:WALMART #1822
Other - Org Name:WAL-MART VISION CENTER #1822
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF SPECIALTY DIVISIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-653-7777
Mailing Address - Street 1:ROAD #3 KM 43.3 INT. 194
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0000
Mailing Address - Country:US
Mailing Address - Phone:787-860-1050
Mailing Address - Fax:787-860-1111
Practice Address - Street 1:STATE ROAD #3 KM 43.3 INT. 194
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-0000
Practice Address - Country:US
Practice Address - Phone:787-860-1050
Practice Address - Fax:787-860-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier