NPIMap

Organization Active NPI

Wal-Mart Puerto Rico Inc

  • Eyewear Supplier
  • Toa Baja, PR
National Provider Identifier
1083964043
Registry record updated Jul 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
WAL-MART PUERTO RICO INC
Practice address
Carr PR 2 Interseccion PR 165
Bo Media Luna
Toa Baja, PR 00949
Phone
(787) 653-8031
NPI assigned
Sep 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Canonic
Title
Sr Director
Phone
(480) 853-0515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

Carr PR 2 Interseccion PR 165
Bo Media Luna
Toa Baja, PR 00949

Mailing address

1 Customer Dr
Ms 0445
Bentonville, AR 72716-0445

Other names 1

  • Walmart Vision Center 30-2346 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ability Network66 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784246400000",
    "number": "1083964043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CUSTOMER DR",
            "address_2": "MS 0445",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR PR 2 INTERSECCION PR 165",
            "address_2": "BO MEDIA LUNA",
            "city": "TOA BAJA",
            "state": "PR",
            "postal_code": "00949",
            "telephone_number": "787-653-8031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART PUERTO RICO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-17",
        "last_updated": "2026-07-17",
        "certification_date": "2026-07-17",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SR DIRECTOR",
        "authorized_official_telephone_number": "480-853-0515"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Vision Center 30-2346",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Toa Baja, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.