Organization
WAL-MART STORES, INC.
Active
Other names
Vision Center 30-1933
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY J BOYD (CONTRACT COORDINATOR)
(479) 277-1359
Entity
Organization
Contact information
Practice address
137 W NORTH AVE, NORTHLAKE, IL 60164-2316
(708) 409-0049
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
08/15/2006
Last updated
09/11/2025
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