Organization
WAL-MART STORES, INC.
Active
Other names
Vision Center 30-5402
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE D GENTILE (NPI COORDINATOR)
(316) 788-5580
Entity
Organization
Contact information
Practice address
4650 WEST NORTH AVE, CHICAGO, IL 60639
(773) 252-8152
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0235
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
09/20/2006
Last updated
09/11/2025
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