NPI: 1285978692 · FORT WORTH, TX 76105 · Optician · NPI assigned 11/26/2012
| Authorized Official | POWERS, AMY (SPECIALIST, PLAN ENROLLMENT) |
| Parent Organization | WAL-MART STORES INC |
| NPI Enumeration Date | 11/26/2012 |
Other providers sharing the same authorized official: POWERS, AMY
| Provider | City | State | Total Paid |
|---|---|---|---|
| WAL-MART STORES TEXAS, LLC | SAN ANTONIO | TX | $109K |
| WAL-MART STORES INC | BLOOMINGDALE | IL | $62K |
| WAL-MART STORES INC | CHICAGO | IL | $19K |
| WAL-MART STORES EAST LP | NEWPORT NEWS | VA | $6K |
| WAL-MART STORES TEXAS, LLC | VICTORIA | TX | $3K |
| WAL-MART STORES TEXAS, LLC | HELOTES | TX | $1K |
| WAL-MART STORES TEXAS LLC | LUCAS | TX | $773.00 |
| Year | Claims | Total Paid |
|---|---|---|
| 2020 | 435 | $6K |
| 2021 | 1,079 | $16K |
| 2022 | 888 | $13K |
| 2023 | 773 | $13K |
| 2024 | 617 | $11K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2020 | Frames, purchases | 1,779 | 1,727 | $34K |
| V2103 | Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens | 952 | 926 | $18K |
| V2104 | Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens | 247 | 242 | $4K |
| V2750 | Anti-reflective coating, per lens | 773 | 761 | $2K |
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | 27 | 25 | $456.50 |
| V2744 | Tint, photochromatic, per lens | 14 | 14 | $85.00 |