Provider Demographics
NPI:1235444522
Name:WALMART SC #2302
Entity Type:Organization
Organization Name:WALMART SC #2302
Other - Org Name:WALMART VISION CENTER #2302
Other - Org Type:Other Name
Authorized Official - Title/Position:RETAIL STRATEGIC BUSINESS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PABON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-653-8094
Mailing Address - Street 1:CARR #2 KM 56.8
Mailing Address - Street 2:BO. FLORIDA AFUERA
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617
Mailing Address - Country:UM
Mailing Address - Phone:787-653-8094
Mailing Address - Fax:479-277-4201
Practice Address - Street 1:CARR #2 KM 56.8
Practice Address - Street 2:BO. FLORIDA AFUERA
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-970-8105
Practice Address - Fax:787-970-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory