Provider Demographics
NPI:1356792899
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:DIRECTOR, HEALTHCARE CONTRACTING AN
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-258-6180
Mailing Address - Street 1:702 SW 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72716-0445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:TIMBERVILLE
Practice Address - State:VA
Practice Address - Zip Code:22853-0000
Practice Address - Country:US
Practice Address - Phone:540-896-0641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAL-MART STORES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty