Organization
WAL-MART STORES INC
Active
Other names
Wal-Mart Vision Center 30-5848
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SAMANTHA DAVENPORT (ENROLLMENT SPECIALIST)
(479) 277-1240
Entity
Organization
Contact information
Practice address
10075 BRUCEVILLE RD, ELK GROVE, CA 95757-9501
(916) 585-7809
(916) 585-7602
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1240
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
02/21/2013
Last updated
02/21/2013
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