Provider Demographics
NPI:1245770759
Name:WAL-MART STORES EAST, LP
Entity Type:Organization
Organization Name:WAL-MART STORES EAST, LP
Other - Org Name:WALMART VISION CENTER 30-3212
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF GOVERNMENT CONTRACTING
Authorized Official - Prefix:
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 1:3212 TBA
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-0000
Mailing Address - Country:US
Mailing Address - Phone:479-258-6180
Mailing Address - Fax:
Practice Address - Street 1:702 SW 8TH ST
Practice Address - Street 2:MAIL STOP 0445
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72716-0445
Practice Address - Country:US
Practice Address - Phone:479-258-6180
Practice Address - Fax:479-277-4331
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAL-MART STORES, INC.L
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty