Organization
WAL-MART STORES EAST, LP
Active
Other names
Vision Center 30-2531
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY J BOYD (CONTRACT COORDINATOR)
(479) 277-1359
Entity
Organization
Contact information
Practice address
3133 E MAIN ST, MOHEGAN LAKE, NY 10547-1521
(914) 526-1100
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0235
(479) 277-1359
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
09/28/2006
Last updated
09/11/2025
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