Organization
WAL-MART SORES, INC.
Active
Other names
Vision Center 30-5192
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY J BOYD (CONTRACT COORDINATOR)
(479) 277-1359
Entity
Organization
Contact information
Practice address
5821 ANTELOPE NORTH RD, ANTELOPE, CA 95843-3927
(916) 729-6254
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0235
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
09/06/2006
Last updated
09/11/2025
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