Wal-Mart Stores, INC

NPI #1073697629 in Bloomington, Illinois

Provider Information

NPI Number: 1073697629
Entity Type: Organization
Organization Name: Wal-Mart Stores, INC
Primary Specialty: Eyewear Supplier
Enumeration Date: Oct 24, 2006
Last Updated: Sep 11, 2025

Practice Location

Address: 2225 W MARKET ST
City: Bloomington
State: Illinois
ZIP Code: 61704-5014
Phone: (309) 828-5646

Authorized Official

Name: NICOLE D GENTILE
Title: NPI COORDINATOR
Phone: (316) 788-5580

Specialties & Taxonomy Codes

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

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