Organization
WAL-MART STORES EAST, LP
Active
Other names
Vision Center 30-4224
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J. SIMMONS (PROVIDER ENROLLMENT SPECIALIST)
(479) 277-9373
Entity
Organization
Contact information
Practice address
201 ZELKOVA CT. NW, CONOVER, NC 28613
(828) 464-4664
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
12/22/2006
Last updated
09/13/2007
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