Provider Demographics
NPI:1053122804
Name:WAL-MART STORES TEXAS, LLC
Entity type:Organization
Organization Name:WAL-MART STORES TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:TOWNZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-204-8452
Mailing Address - Street 1:702 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72716-0445
Mailing Address - Country:US
Mailing Address - Phone:479-371-2827
Mailing Address - Fax:479-277-4331
Practice Address - Street 1:8927 FRY RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5143
Practice Address - Country:US
Practice Address - Phone:832-349-7802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No332H00000XSuppliersEyewear Supplier