WAL-MART STORES TEXAS, LLC
NPI: 1326452160
· SAN ANTONIO, TX 78231
· Optician
· NPI assigned 06/19/2014
$883.26
Total Medicaid Paid
Provider Details
| Authorized Official | LEVINE, LAURA (DIRECTOR, HEALTHCARE CONTRACTING AN) |
| Parent Organization | WAL-MART STORES, INC. |
| NPI Enumeration Date | 06/19/2014 |
Related Entities
Other providers sharing the same authorized official: LEVINE, LAURA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
12 |
$883.26 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
12 |
12 |
$883.26 |