NPI |
1174607717 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
WAL-MART STORES EAST, LP |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Other Organization Name |
VISION CENTER 30-0332 |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
3 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
6140A UNIVERSITY DR. |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
HUNTSVILLE |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
AL |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address Postal Code |
35806 |
The city name in the location address of the provider being identified. |
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 |
2568377272 |
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 Enumeration Date |
10/24/2006 |
The country code in the location address of the provider being identified. |
Last Update Date |
8/22/2020 |
The telephone number associated with the location address of the provider being identified. |
Authorized Official Last Name |
GENTILE |
The fax number associated with the location
address of the provider being identified. |
Authorized Official First Name |
NICOLE |
The date the provider was assigned a unique identifier (assigned an NPI). |
Authorized Official Middle Name |
D |
The date that a record was last updated or changed. |
Authorized Official Title or Position |
NPI COORDINATOR |
The code designating the provider’s gender if the provider is a person. |
Authorized Official Telephone Number |
3167885580 |
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 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 |
|