Organization · Type 2 NPI

Wal-Mart Puerto Rico Inc

Eyewear Supplier · Carolina, PR

NPI number 1114054517 Active

Practice location

Parque Escorial, Bo. San Anton State Rd. #3
Carolina, PR 00792-0000

Call (787) 257-0500 Map

Fax (787) 257-0670

Mailing address

1 Customer Dr, Ms 0445
Bentonville, AR 72716-0445

Specialties and licenses

Taxonomy	Code	License
Eyewear Supplier Primary	332H00000X	None listed

Eyewear Supplier: An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

Other eyewear supplier providers in Carolina

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NPI record

NPI: 1114054517
Entity type: Organization (Type 2)
Issued: Feb 27, 2007
Last updated: Jul 17, 2026
Status: Active

Other names

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Walmart Vision Center 30-2423 · doing business as
Walmart Vision Center #2423 · other name

Authorized official

Kimberly Canonic
SR Director
(480) 853-0515

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1114054517

Wal-Mart Puerto Rico Inc's National Provider Identifier is 1114054517, issued on Feb 27, 2007. The primary taxonomy on file is Eyewear Supplier (332H00000X), and the practice location is in Carolina, PR. The record was last updated on Jul 17, 2026.