OrganizationActive
Wal-Mart Stores East, Lp
NPI 1104361500 · Eyewear Supplier · Stoughton, WI
Wal-Mart Stores East, Lp is a Eyewear Supplier organization in Stoughton, WI (NPI 1104361500).
Provider details
- NPI number
- 1104361500
- Entity type
- Organization
- Primary specialty
- Eyewear SupplierSuppliers
- Parent organization
- Wal-Mart Stores, Inc.
- Organization subpart
- Yes
- Authorized official
- Kimberly Canonic, Sr. Director(480) 853-0515
Specialties & taxonomies
Suppliers
- Optician156FX1800X
Eye and Vision Services Providers
Profile Score
Established profile(71/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2600 State Hwy 138
Stoughton, WI 53589-3701
Phone: (608) 501-6101
Fax: (608) 877-0428
Street-level locationGet directions
Mailing address
1 Customer Dr
Bentonville, AR 72716-0445
Other names (DBA / former)
- Doing business as
- Walmart Vision Center 30-1176
Registry dates
- Enumerated
- 2016-12-21
- Last updated
- 2026-04-27
- Certified
- 2026-04-27
Frequently asked questions
- What is Wal-Mart Stores East, Lp's NPI number?
- Wal-Mart Stores East, Lp's National Provider Identifier (NPI) is 1104361500, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Wal-Mart Stores East, Lp?
- Wal-Mart Stores East, Lp is classified in the NPPES registry as Eyewear Supplier (Suppliers).
- Where is Wal-Mart Stores East, Lp located?
- Wal-Mart Stores East, Lp's practice location on file with NPPES is 2600 State Hwy 138, Stoughton, WI 53589-3701.
- What is Wal-Mart Stores East, Lp's phone number?
- The practice phone number listed in the NPPES registry for Wal-Mart Stores East, Lp is (608) 501-6101.
- Who is the authorized official for Wal-Mart Stores East, Lp?
- The authorized official listed on Wal-Mart Stores East, Lp's NPPES record is Kimberly Canonic, Sr. Director. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Wal-Mart Stores East, Lp's NPI active?
- Yes — Wal-Mart Stores East, Lp's NPI (1104361500) is active in the NPPES registry as of the last update on 2026-04-27.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.