Wal-Mart Stores INC

NPI #1891000147 in Grimes, Iowa

Provider Information

NPI Number: 1891000147
Entity Type: Organization
Organization Name: Wal-Mart Stores INC
Primary Specialty: Eyewear Supplier
Enumeration Date: Aug 11, 2010
Last Updated: Aug 11, 2010

Practice Location

Address: 2150 EAST 1ST ST.
City: Grimes
State: Iowa
ZIP Code: 50111
Phone: (515) 986-1783

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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