Wal-Mart Stores East, LP

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

WAL-MART STORES EAST, LP

Doing business as

Walmart Vision Center 30-3909

Practice address

150 Foundry LN
St Augustine, FL 32092-1842

Phone

(904) 617-6343

NPI assigned

Sep 22, 2026

Last updated

Sep 22, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly Canonic

Title

Sr. Director, Billing

Phone

(480) 853-0515

Specialties & licenses 2

Addresses

Other names 1

• Walmart Vision Center 30-3909 Doing business as

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

{
    "created_epoch": "1790035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790035200000",
    "number": "1093627168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CUSTOMER DR # MS 0445",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 FOUNDRY LN",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320921842",
            "telephone_number": "904-617-6343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-22",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SR. DIRECTOR, BILLING",
        "authorized_official_telephone_number": "480-853-0515"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Vision Center 30-3909",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gretchen Wade, CCC, SLP
• Rebecca Mary Wagner, PHARMD
• Sze Wai, O.D.
• Sharon E Wait Oreilly, MA
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0579)
• Wal-Mart Stores East, LP (Walmart Pharmacy 10-3909)
• Wal-Mart Stores East, LP (Vision Center 30-0579)
• Vanessa M Walcott
• Walgreen Co (Walgreens #03247)
• Walgreen Co (Walgreens #11485)

• Optician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Optician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.