Wal-Mart Stores, INC

NPI #1205926441 in Roseburg, Oregon

Provider Information

NPI Number: 1205926441
Entity Type: Organization
Organization Name: Wal-Mart Stores, INC
Primary Specialty: Eyewear Supplier
Enumeration Date: Oct 16, 2006
Last Updated: Sep 11, 2025

Practice Location

Address: 2125 NW STEWART PKWY
City: Roseburg
State: Oregon
ZIP Code: 97470-1693
Phone: (541) 957-8550

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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