NPIMap

Organization Active NPI

Wal-Mart Stores Texas, LLC

Doing business as Walmart Vision Center 30-7281

  • Eyewear Supplier
  • San Angelo, TX
National Provider Identifier
1578923868
Registry record updated May 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
WAL-MART STORES TEXAS, LLC
Doing business as
Walmart Vision Center 30-7281
Practice address
3440 S. Bryant Blvd
San Angelo, TX 76903
Phone
(325) 276-6598
Fax
(325) 276-6597
NPI assigned
Feb 29, 2016
Last updated
May 11, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
WAL-MART STORES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 11, 2016

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

Authorized official

Name
Laura Levine
Title
Dir Healthcare Contract&Enrolment
Phone
(479) 204-8550

Specialties & licenses 2

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

Addresses

Primary practice location

3440 S. Bryant Blvd
San Angelo, TX 76903

Mailing address

702 SW 8TH St
Mailstop 0445
Bentonville, AR 72716-0445
Phone (479) 204-8550

Other identifiers 1

IdentifierTypeStateIssuer
470088MedicaidTX

Other names 1

  • Walmart Vision Center 30-7281 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wal-Mart Store Texas LP879 organizations share this tax ID, including this one
Part of
Walmart Pharmacy 10-206

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

3440 S Bryant Blvd
San Angelo, TX 76903
Phone (325) 276-6598

NPI Registry JSON

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

{
    "created_epoch": "1456704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462924800000",
    "number": "1578923868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "address_2": "MAILSTOP 0445",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445",
            "telephone_number": "479-204-8550",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3440 S. BRYANT BLVD",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "76903",
            "telephone_number": "325-276-6598",
            "fax_number": "325-276-6597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES TEXAS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES, INC.",
        "enumeration_date": "2016-02-29",
        "last_updated": "2016-05-11",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DIR HEALTHCARE CONTRACT&ENROLMENT",
        "authorized_official_telephone_number": "479-204-8550"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "470088",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Vision Center 30-7281",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Angelo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2016; 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.