Organization
WAL-MART STORES, INC.
Active
Other names
Vision Center 30-3602
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J SIMMONS (NPI ASSOCIATE)
(479) 277-9373
Entity
Organization
Contact information
Practice address
1100 LEJUNE DR, SPRINGFIELD, IL 62703-4537
(217) 529-6336
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0235
(479) 277-9373
(479) 277-8176
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
07/02/2008
Last updated
07/02/2008
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