Wal-Mart Stores INC

NPI #1063760817 in Brooklyn Center, Minnesota

Provider Information

NPI Number: 1063760817
Entity Type: Organization
Organization Name: Wal-Mart Stores INC
Primary Specialty: Eyewear Supplier
Enumeration Date: Aug 28, 2012
Last Updated: Aug 30, 2012

Practice Location

Address: 1200 SHINGLE CREEK CROSSING
City: Brooklyn Center
State: Minnesota
ZIP Code: 55430
Phone: (763) 566-4065

Authorized Official

Name: DIANNA PAINTER
Title: ENROLLMENT SPECIALIST
Phone: (479) 277-1238

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician/Technologist - Optician — Optician	156FX1800X
Eyewear Supplier	332H00000X	Primary

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