Organization
WAL-MART STORES, INC
Active
Other names
Wal-Mart Vision Center 30-2196
Organization subpart
No
Provider details
NPI number
Authorized official
DIANNA D PAINTER (ENROLLMENT SPECIALIST)
(479) 277-1238
Entity
Organization
Contact information
Practice address
3411 E KOLONELES WAY, PORT ANGELES, WA 98362
(360) 452-6131
Mailing address
702 SW 8TH ST., BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
10/16/2006
Last updated
07/28/2011
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