Provider Demographics
NPI: | 1891553186 |
---|---|
Name: | WAL-MART STORES EAST, LP |
Entity Type: | Organization |
Organization Name: | WAL-MART STORES EAST, LP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SENIOR DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHELE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GARVEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 479-277-2611 |
Mailing Address - Street 1: | 702 SW 8TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | BENTONVILLE |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72716-0445 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 479-371-2827 |
Mailing Address - Fax: | 479-277-4331 |
Practice Address - Street 1: | 3301 SW 104TH ST |
Practice Address - Street 2: | |
Practice Address - City: | OKLAHOMA CITY |
Practice Address - State: | OK |
Practice Address - Zip Code: | 73159-7043 |
Practice Address - Country: | US |
Practice Address - Phone: | 405-300-6573 |
Practice Address - Fax: | 405-300-6583 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-03-11 |
Last Update Date: | 2024-03-11 |
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 - Multi-Specialty |
No | 332H00000X | Suppliers | Eyewear Supplier |