NPIMap

Organization Active NPI

Wal-Mart Stores East, LP

  • Eyewear Supplier
  • Jacksonville, FL
National Provider Identifier
1598856882
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
WAL-MART STORES EAST, LP
Practice address
10991 San Jose Blvd Ste 1
Jacksonville, FL 32223-6600
Phone
(904) 260-4402
NPI assigned
Sep 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 156FX1800X
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

10991 San Jose Blvd Ste 1
Jacksonville, FL 32223-6600

Mailing address

702 SW 8TH St.
Bentonville, AR 72716-0235

Other names 1

  • Vision Center 30-1082 Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2207029Wal-Mart Stores East, LP10991 San Jose Blvd Ste 1, Jacksonville, FL 32223Certificate of waiverDec 22, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Wal-Mart Pharmacy 10-108210991 San Jose Blvd Ste 1, Jacksonville, FL 32223-6600(904) 260-4407 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Ostomy Supplies|Prosthetic Lenses: Conventional Eyeglasses|Enteral Nutrients|Surgical Dressings Does not accept assignmentParticipating since Jul 1, 2014

National Provider Directory

National Provider Directory
Tax ID family
Ability Network4,651 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": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1598856882",
    "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": "10991 SAN JOSE BLVD STE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322236600",
            "telephone_number": "904-260-4402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "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 30-1082",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.