Provider Demographics
NPI:1467615724
Name:WALMART SC #5802
Entity Type:Organization
Organization Name:WALMART SC #5802
Other - Org Name:WALMART VISION CENTER #5802
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH & BEAUTY BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KYLMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-653-7777
Mailing Address - Street 1:PLAZA CANOVANAS PR #3 KM 17.8
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-653-7777
Mailing Address - Fax:479-277-4201
Practice Address - Street 1:PLAZA CANOVANAS PR # 3 KM 17.8
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-653-7777
Practice Address - Fax:479-277-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory