NPIMap

Organization Active NPI

Walmart Stores, Inc.

Doing business as Vision Center 30-1789

  • Eyewear Supplier
  • Lodi, CA
National Provider Identifier
1568548766
Registry record updated Oct 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
WALMART STORES, INC.
Doing business as
Vision Center 30-1789
Practice address
2350 W Kettleman LN
Lodi, CA 95242-9762
Phone
(209) 368-6696
NPI assigned
Oct 31, 2006
Last updated
Oct 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2025

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
(479) 371-1168

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary
Optician 156FX1800X

Addresses

Primary practice location

2350 W Kettleman LN
Lodi, CA 95242-9762

Mailing address

1 Customer Dr, Ms 0445
Bentonville, AR 72716-0235

Other names 1

  • Vision Center 30-1789 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ability Network2,173 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

Locations

2350 W Kettleman Ln
Lodi, CA 95242
Phone (209) 368-6658

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759363200000",
    "number": "1568548766",
    "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": "727160235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 W KETTLEMAN LN",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952429762",
            "telephone_number": "209-368-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART STORES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SR. DIRECTOR",
        "authorized_official_telephone_number": "479-371-1168"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Center 30-1789",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lodi, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2025; 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.