Provider Demographics
NPI:1023144474
Name:WALMART #1854
Entity type:Organization
Organization Name:WALMART #1854
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIALTY DIVISIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-653-7777
Mailing Address - Street 1:STATE RD #2 KM 81.9
Mailing Address - Street 2:BO. CARRIZALES
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0000
Mailing Address - Country:US
Mailing Address - Phone:787-817-2160
Mailing Address - Fax:787-817-2510
Practice Address - Street 1:STATE RD #2 KM 81.9
Practice Address - Street 2:BO. CARRIZALES
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-0000
Practice Address - Country:US
Practice Address - Phone:787-817-2160
Practice Address - Fax:787-817-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier