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Wal-Mart Stores, Inc

Organization Active NPI Eyewear Supplier · Ponderay, ID

NPI 1114017357 · NPPES record last updated Sep 11, 2025

Key facts

NPI
1114017357
Entity type
Organization (NPI type 2)
Primary specialty
Eyewear Supplier 332H00000X
Legal business name
WAL-MART STORES, INC
Practice address
476999 Highway 95
Ponderay, ID 83852-9738
Phone
(208) 265-8332
NPI assigned
Oct 16, 2006
Organization subpart
No

Authorized official

Name
Nicole D Gentile
Title
Npi Coordinator
Phone
(316) 788-5580

Corporate family (same tax ID) 17

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Ability Network (2,173 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 156FX1800X
Eyewear Supplier 332H00000X Yes

Addresses

Primary practice location

476999 Highway 95
Ponderay, ID 83852-9738

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0235

Other names

  • Vision Center 30-2485 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 11, 2025.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1114017357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "476999 HIGHWAY 95",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "838529738",
            "telephone_number": "208-265-8332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "GENTILE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "NPI COORDINATOR",
        "authorized_official_telephone_number": "316-788-5580"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Center 30-2485",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ponderay, ID

All providers in Ponderay, ID · Eyewear Supplier in Idaho

Sources for this page

Verify at the official NPI Registry.