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Wal-Mart Stores East , Lp — NPI 1902771173, Broken Arrow, OK | NPI Central

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NPI 1902771173

OrganizationActive

Wal-Mart Stores East , Lp

NPI 1902771173 · Optician · Broken Arrow, OK

Provider details

NPI number: 1902771173
Entity type: Organization
Primary specialty: OpticianEye and Vision Services Providers
Organization subpart: No
Authorized official: Kimberly Canonic, Senior Director(479) 371-1168

Specialties & taxonomies

OpticianPrimary156FX1800X
Eye and Vision Services Providers
Eyewear Supplier332H00000X
Suppliers

Practice location

2301 W Kenosha St

Broken Arrow, OK 74012-8912

Phone: (918) 505-6908

Fax: (918) 505-6909

Approximate (ZIP-level) locationGet directions

More OK providers

Mailing address

1 Customer Dr

Bentonville, AR 72716-0445

Other names (DBA / former)

Doing business as: Walmart Pharmacy 10-0472

Registry dates

Enumerated: 2025-10-08
Last updated: 2025-10-08
Certified: 2025-10-08

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.