Wal-Mart Stores East, LP
NPI #1164503298 in Mountain Grove, Missouri
Provider Information
- NPI Number
- 1164503298
- Entity Type
- Organization
- Organization Name
- Wal-Mart Stores East, LP
- Primary Specialty
- Eyewear Supplier
- Enumeration Date
- Oct 17, 2006
- Last Updated
- Sep 11, 2025
Practice Location
- Address
- 2100 N MAIN AVE
- City
- Mountain Grove
- State
- Missouri
- ZIP Code
- 65711-2438
- Phone
- (417) 926-5107
Authorized Official
- Name
- NICOLE D GENTILE
- Title
- NPI COORDINATOR
- Phone
- (316) 788-5580
Specialties & Taxonomy Codes
| Specialty |
|---|
| Technician/Technologist - Optician — Optician |
| Eyewear Supplier |
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