Wal-Mart Stores East, LP

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

WAL-MART STORES EAST, LP

Doing business as

Walmart Vision Center 30-2779

Practice address

41176 Hwy 27
Davenport, FL 33837-1005

Phone

(479) 277-3665

NPI assigned

Sep 18, 2026

Organization subpart

No

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

Authorized official

Name

Kimberly Canonic

Title

Director, Billing

Phone

(480) 853-0515

Specialties & licenses 2

Addresses

Other names 1

• Walmart Vision Center 30-2779 Doing business as

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

{
    "created_epoch": "1789689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789689600000",
    "number": "1760394472",
    "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": "727160445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41176 HWY 27",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338371005",
            "telephone_number": "479-277-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-18",
        "last_updated": "2026-09-18",
        "certification_date": "2026-09-16",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "DIRECTOR, BILLING",
        "authorized_official_telephone_number": "480-853-0515"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Vision Center 30-2779",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vitallink Transportation
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• Matthew Volker, LMHC
• Wolf Karl Von Waagner, MD
• Wal-Mart Stores East, LP (Walmart Pharmacy 10-2779)
• Walgreen Co (Walgreens # 11104)
• Walgreen Co (Walgreens #06217)
• Cleveland Wallace
• Kaysey Wann, MA, EDM, NCSP, LSP
• Christian Sean Watkins

• Optician in Davenport, FL
• Providers in Davenport, FL by specialty
• Optician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.