Organization
WAL-MART STORES, INC
Active
Other names
Vision Center 30-4284
Organization subpart
No
Provider details
NPI number
Authorized official
MR. G WESLEY CRAINSHAW III (PROVIDER ENROLLMENT SPECIALIST)
(479) 277-1850
Entity
Organization
Contact information
Practice address
440 WADSWORTH BLVD, LAKEWOOD, CO 80226-1510
(303) 205-0772
(303) 205-0774
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0235
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
01/08/2007
Last updated
09/13/2007
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