Organization Name: | WAL-MART STORES EAST, LP |
NPI Number: | 1285795898 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BJ RICE (PROVIDER ENROLLMENT SPECIALIST) |
Mailing Address: | 4858 Hwy 1 Mathews |
State: | LA US |
Postal Code: | 70394 |
Phone Number: | 9855323939 |
Fax Number: | |
NPI Enumeration Date: | 12/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |