Provider Demographics
NPI:1609382241
Name:WALMART VISION CENTER
Entity Type:Organization
Organization Name:WALMART VISION CENTER
Other - Org Name:WALMART INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:VISION CENTER MANAGER/LDO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DANAHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-526-1110
Mailing Address - Street 1:3133 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1521
Mailing Address - Country:US
Mailing Address - Phone:914-526-1110
Mailing Address - Fax:
Practice Address - Street 1:3133 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1521
Practice Address - Country:US
Practice Address - Phone:914-526-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006376156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty