| Organization Name: | WAL-MART STORES, INC |
| NPI Number: | 1063800175 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEB LAUVER (SPECIALIST PLAN ENROLLMENT) |
| Mailing Address: | 1800 N 16th St Council Bluffs |
| State: | IA US |
| Postal Code: | 515010123 |
| Phone Number: | 7128903916 |
| Fax Number: | 7123520288 |
| NPI Enumeration Date: | 12/26/2014 |
| NPI Last Update Date: | 12/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |