NPIMap

Organization Active NPI

Wal-Mart Puerto Rico Inc

Doing business as Walmart Vision Center 30-5802

  • Clinical Medical Laboratory
  • Canovanas, PR
National Provider Identifier
1467615724
Registry record updated Jul 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
WAL-MART PUERTO RICO INC
Doing business as
Walmart Vision Center 30-5802
Practice address
Plaza Canovanas PR # 3 KM 17.8
Canovanas, PR 00729
Phone
(787) 653-7777
Fax
(479) 277-4201
NPI assigned
Jul 8, 2008
Last updated
Jul 17, 2026By the provider in NPPES
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
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

Plaza Canovanas PR # 3 KM 17.8
Canovanas, PR 00729

Mailing address

1 Customer Dr
Ms 0445
Bentonville, AR 72716-0445

Other names 2

  • Walmart Vision Center 30-5802 Doing business as
  • Walmart Vision Center #5802 Other name

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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784246400000",
    "number": "1467615724",
    "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": "PLAZA CANOVANAS PR # 3 KM 17.8",
            "city": "CANOVANAS",
            "state": "PR",
            "postal_code": "00729",
            "telephone_number": "787-653-7777",
            "fax_number": "479-277-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART PUERTO RICO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-08",
        "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": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Vision Center 30-5802",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Walmart Vision Center #5802",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Canovanas, 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.