Organization
WAL-MART STORES EAST, LP
Active
Other names
Vision Center 30-5088
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY J BOYD (CONTRACT COORDINATOR)
(479) 277-1359
Entity
Organization
Contact information
Practice address
450 STEWART LN, TRIADELPHIA, WV 26059-1020
(304) 547-9017
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0235
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
11/03/2006
Last updated
02/22/2008
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