Provider Demographics
NPI: | 1609951011 |
---|---|
Name: | WALMART INC. |
Entity Type: | Organization |
Organization Name: | WALMART INC. |
Other - Org Name: | VISION CENTER 30-2751 |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MATTHEW |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MCMULLIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 479-371-8711 |
Mailing Address - Street 1: | 702 SW 8TH STREET |
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: | 601 ENGLEWOOD PKWY |
Practice Address - Street 2: | |
Practice Address - City: | ENGLEWOOD |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80110-2374 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-789-7201 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-10-25 |
Last Update Date: | 2023-12-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 156FX1800X | Eye and Vision Services Providers | Technician/Technologist | Optician | Group - Single Specialty |
No | 332H00000X | Suppliers | Eyewear Supplier | Group - Single Specialty |