| Organization Name: | WAL-MART STORES, INC |
| NPI Number: | 1104294065 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAURA LEVINE (DIRECTOR) |
| Mailing Address: | 505 Riverstone Pkwy Kankakee |
| State: | IL US |
| Postal Code: | 609017207 |
| Phone Number: | 4792048550 |
| Fax Number: | 4792774331 |
| NPI Enumeration Date: | 09/09/2015 |
| NPI Last Update Date: | 09/11/2015 |
| 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: | |