NPIMap

Organization Active NPI

Wal-Mart Stores, Inc. Dba Wal-Mart

  • Eyewear Supplier
  • Waukegan, IL
National Provider Identifier
1710015219
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, INC. DBA WAL-MART
Practice address
3900 Fountain Square PL
Waukegan, IL 60085-6705
Phone
(847) 473-2193
NPI assigned
Feb 28, 2007
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
David J. Simmons
Title
Npi Associate
Phone
(479) 277-9373

Specialties & licenses 2

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

Addresses

Primary practice location

3900 Fountain Square PL
Waukegan, IL 60085-6705

Mailing address

702 SW 8TH Street
Bentonville, AR 72716-0235
Phone (479) 277-9373

Other names 1

  • Vision Center 3891 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

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1710015219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH STREET",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160235",
            "telephone_number": "479-277-9373",
            "fax_number": "479-277-8176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 FOUNTAIN SQUARE PL",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600856705",
            "telephone_number": "847-473-2193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES, INC. DBA WAL-MART",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "NPI ASSOCIATE",
        "authorized_official_telephone_number": "479-277-9373"
    },
    "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 3891",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waukegan, IL

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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.