Organization Name: | WAL-MART STORES EAST, LP |
NPI Number: | 1508920406 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID J. SIMMONS (PROVIDER ENROLLMENT SPECIALIST) |
Mailing Address: | 201 Zelkova Ct. Nw Conover |
State: | NC US |
Postal Code: | 28613 |
Phone Number: | 8284644664 |
Fax Number: | |
NPI Enumeration Date: | 12/22/2006 |
NPI Last Update Date: | 09/13/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332H00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
Taxonomy Specialization: | |
Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |