Provider Demographics
NPI:1811048713
Name:WAL-MART VISION CENTER
Entity type:Organization
Organization Name:WAL-MART VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VISION CENTER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ONOFRIO
Authorized Official - Middle Name:SAM
Authorized Official - Last Name:MELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-227-2290
Mailing Address - Street 1:100 ELMRIDGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 ELMRIDGE CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3459
Practice Address - Country:US
Practice Address - Phone:585-227-2290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty