Wal-Mart Puerto Rico INC

NPI #1700188877 in Fajardo, Puerto Rico

Provider Information

NPI Number: 1700188877
Entity Type: Organization
Organization Name: Wal-Mart Puerto Rico INC
Subpart: Yes (part of a larger organization)
Parent Organization: WAL-MART STORES INC
Primary Specialty: Eyewear Supplier
Enumeration Date: Nov 23, 2010
Last Updated: Nov 23, 2010

Practice Location

Address: 150 CARR 940
Address 2: STE 180
City: Fajardo
State: Puerto Rico
ZIP Code: 00738
Phone: (787) 801-0504

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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