Wal-Mart Stores East, LP
Technician/Technologist, Optician in Portage, WI. Organization (NPI-2).
NPI number1043391964
StatusActive
Last updated in NPPESOct 26, 2026
Details
- NPI
- 1043391964
- Entity type
- Organization (NPI-2)
- Legal business name
- Wal-Mart Stores East, LP
- Organization subpart
- No
- Enumeration date
- Oct 18, 2006
- Certification date
- Oct 26, 2026
- Last updated
- Oct 26, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 156FX1800X | Technician/Technologist, Optician | – | – | Yes |
| 332H00000X | Eyewear Supplier (Equipment, not the service) | – | – |
Other names
- Vision Center 30-1799 (Doing Business As)
Practice location
2950 New Pinery RdPortage, WI 53901-9225
Phone 608-742-1432
Mailing address
1 Customer DrBentonville, AR 72716-0235
Phone 479-277-3665 · Fax 479-277-4331
Authorized official
Kimberly Canonic
Director Of Health Care Contracting
4808530515
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