| NPI |
1144301755 |
The first name of the provider, if the provider
is an individual. |
| Entity Type Code |
2 |
The middle name of the provider, if the provider
is an individual. |
| Employer Identification Number EIN |
|
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
| Provider Organization Name Legal Business Name |
WAL-MART STORES EAST, LP |
The date that a record was last updated or changed. |
| Provider Other Organization Name |
VISION CENTER 30-3588 |
The country code in the location address of the provider being identified. |
| Provider Other Organization Name Type Code |
3 |
The telephone number associated with the location address of the provider being identified. |
| Provider First Line Business Practice Location Address |
17041 JEFFERSON DAVIS HWY |
The fax number associated with the location
address of the provider being identified. |
| Provider Business Practice Location Address City Name |
DUMFRIES |
The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address State Name |
VA |
The middle name of the provider, if the provider
is an individual. |
| Provider Business Practice Location Address Postal Code |
220262129 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The State code in the location of the provider
being identified. |
| Provider Business Practice Location Address Telephone Number |
7032214116 |
The code designating the provider’s gender if the provider is a person. |
| Provider Enumeration Date |
10/18/2006 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date |
8/22/2020 |
The date that a record was last updated or changed. |
| Authorized Official Last Name |
EPPERSON |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Authorized Official First Name |
LINDA |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Authorized Official Middle Name |
M. |
The date that a record was last updated or changed. |
| Authorized Official Title or Position |
NPI COORDINATOR |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| Authorized Official Telephone Number |
3167885580 |
The 10-position telephone number of the authorized official. |
| Healthcare Provider Taxonomy Code 1 |
156FX1800X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Healthcare Provider Primary Taxonomy Switch 1 |
X |
|
| Healthcare Provider Taxonomy Code 2 |
332H00000X |
|
| Healthcare Provider Primary Taxonomy Switch 2 |
X |
|
| Is Organization Subpart |
N |
|
| Healthcare Provider Taxonomy Group 1 |
193400000X MULTIPLE SINGLE SPECIALTY GROUP |
|