Organization
WAL-MART PUERTO RICO INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sams Club Optical 30-6689
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES INC
Authorized official
DIANNA PAINTER (ENROLLMENT SPECIALIST)
(479) 277-1238
Entity
Organization
Contact information
Practice address
PLAZA CENTRO II, AVE MUNOZ MARIN, CAGUAS, PR 00725
(787) 746-1039
(787) 746-1664
Mailing address
702 SW 8TH ST., BENTONVILLE, AR 72716
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
12/02/2010
Last updated
03/12/2025
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