# WAL-MART STORES EAST, LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walmart Vision Center 30-1130
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417883091
- **Authorized official:** KIMBERLY CANONIC (DIRECTOR OF HEALTH CARE CONTRACTING)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 922 E MAIN ST, LAURENS, SC 29360-3616
- **Practice address phone:** (864) 682-8111
- **Mailing address:** 1 CUSTOMER DR \# MS 0445, BENTONVILLE, AR 72716-0445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 156FX1800X | Optician | — | NULL | — |
| 156FX1800X | Optician | — | — | — |
| 332H00000X | Eyewear Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 06/22/2026
- **Last updated:** 06/22/2026