Organization
WAL-MART STORES INC
Active
Other names
Vision Center 30-4695
Organization subpart
No
Provider details
NPI number
Authorized official
DIANNA PAINTER (ENROLLMENT SPECIALIST)
(479) 277-1238
Entity
Organization
Contact information
Practice address
6660 GODFREY RD, GODFREY, IL 62035
(618) 466-3878
Mailing address
702 SW 8TH ST., BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
10/28/2010
Last updated
10/28/2010
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