Organization · Type 2 NPI

Wal-Mart Stores Inc

Eyewear Supplier · Wood River, IL

NPI number 1508103078 Active

Practice location

610 Wesley Dr
Wood River, IL 62095-1894

Call (618) 259-1286 Map

Mailing address

702 SW 8th St
Bentonville, AR 72716-0445

Specialties and licenses

Taxonomy	Code	License
Optician	156FX1800X	None listed
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.

6 other providers at this address

Other eyewear supplier providers in Wood River

See all in Wood River →

NPI record

NPI: 1508103078
Entity type: Organization (Type 2)
Issued: Jan 3, 2013
Last updated: Jan 3, 2013
Status: Active
Subpart: Yes of Wal-Mart Stores Inc

Other names

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Wal-Mart Vision Center 30-1071 · doing business as

Authorized official

Amy Powers
Specialist, Plan Enrollment
(479) 204-0709

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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 1508103078

Wal-Mart Stores Inc's National Provider Identifier is 1508103078, issued on Jan 3, 2013. The primary taxonomy on file is Eyewear Supplier (332H00000X), and the practice location is in Wood River, IL. The record was last updated on Jan 3, 2013.