Organization Name: | WAL-MART STORES EAST LP |
NPI Number: | 1265776579 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AMY POWERS (SPECIALIST, PLAN ENROLLMENT) |
Mailing Address: | 1936 N. Lecanto Hwy Lecanto |
State: | FL US |
Postal Code: | 34461 |
Phone Number: | 3522286003 |
Fax Number: | |
NPI Enumeration Date: | 11/27/2012 |
NPI Last Update Date: | 11/27/2012 |
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: |