Organization Name: | WAL-MART STORES EAST, LP |
NPI Number: | 1194164996 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LAURA LEVINE (MGR GOV CONTRACTING) |
Mailing Address: | 935 State Hwy 11 South Sweetwater |
State: | TN US |
Postal Code: | 37874 |
Phone Number: | 4233377900 |
Fax Number: | 4233377902 |
NPI Enumeration Date: | 06/14/2013 |
NPI Last Update Date: | 06/19/2013 |
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: |