Provider Demographics
NPI:1538297080
Name:WALMART SC #3693
Entity Type:Organization
Organization Name:WALMART SC #3693
Other - Org Name:WALMART VISION CENTER #3693
Other - Org Type:Other Name
Authorized Official - Title/Position:DIR 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:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-0780
Mailing Address - Country:US
Mailing Address - Phone:787-971-1005
Mailing Address - Fax:787-845-0411
Practice Address - Street 1:PLAZA SANTA ISABEL
Practice Address - Street 2:STATE RD #153
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-0000
Practice Address - Country:US
Practice Address - Phone:787-971-1005
Practice Address - Fax:787-845-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier