Wal-Mart Stores East, LP

NPI #1184098733 in Horn Lake, Mississippi

Provider Information

NPI Number: 1184098733
Entity Type: Organization
Organization Name: Wal-Mart Stores East, LP
Subpart: Yes (part of a larger organization)
Parent Organization: WAL-MART STORES, INC.
Primary Specialty: Eyewear Supplier
Enumeration Date: Nov 19, 2015
Last Updated: Nov 19, 2015

Practice Location

Address: 4150 GOODMAN ROAD WEST
City: Horn Lake
State: Mississippi
ZIP Code: 38637
Phone: (662) 253-6179

Authorized Official

Name: LAURA LEVINE
Title: DIR HEALTHCARE CONTRACT & ENROLLMNE
Phone: (479) 204-8550

Specialties & Taxonomy Codes

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

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