Organization Name: | WAL-MART STORES EAST LP |
NPI Number: | 1104180256 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LAURA LEVINE (DIR HEALTHCARE CONTRACT & ENROLL) |
Mailing Address: | 866 Niagara Falls Blvd North Tonawanda |
State: | NY US |
Postal Code: | 141202006 |
Phone Number: | 7162434159 |
Fax Number: | |
NPI Enumeration Date: | 07/03/2012 |
NPI Last Update Date: | 05/16/2016 |
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: |