Provider Demographics
NPI:1548415516
Name:WAL-MART STORES INC.
Entity Type:Organization
Organization Name:WAL-MART STORES INC.
Other - Org Name:VISION CENTER 30-6520
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HURD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-204-8932
Mailing Address - Street 1:702 SW 8RH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72716-0235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5565 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-4632
Practice Address - Country:US
Practice Address - Phone:772-978-9385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty