Provider Demographics
NPI:1487858445
Name:WALMART VISION CENTER
Entity Type:Organization
Organization Name:WALMART VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHRAMEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-842-2439
Mailing Address - Street 1:1706 W REYNOLDS ST
Mailing Address - Street 2:WALMART VISION CENTER
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-9695
Mailing Address - Country:US
Mailing Address - Phone:815-842-2439
Mailing Address - Fax:815-842-2452
Practice Address - Street 1:1706 W REYNOLDS ST
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-9695
Practice Address - Country:US
Practice Address - Phone:815-842-2439
Practice Address - Fax:815-842-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty