NPI: 1386984656 · SAN ANTONIO, TX 78244 · Optician · NPI assigned 02/25/2013
| Authorized Official | POWERS, AMY (SPECIALIST, PLAN ENROLLMENT) |
| Parent Organization | WAL-MART STORES, INC. |
| NPI Enumeration Date | 02/25/2013 |
Other providers sharing the same authorized official: POWERS, AMY
| Provider | City | State | Total Paid |
|---|---|---|---|
| WAL-MART STORES INC | BLOOMINGDALE | IL | $62K |
| WAL-MART STORES TEXAS LLC | FORT WORTH | TX | $59K |
| 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 | 175 | $5K |
| 2021 | 1,216 | $35K |
| 2022 | 736 | $24K |
| 2023 | 832 | $27K |
| 2024 | 579 | $19K |
| Code | Description | Claims | Bene. Records | Total Paid |
|---|---|---|---|---|
| V2025 | Deluxe frame | 1,113 | 1,109 | $75K |
| V2103 | Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens | 1,073 | 1,066 | $18K |
| V2750 | Anti-reflective coating, per lens | 927 | 922 | $8K |
| V2020 | Frames, purchases | 283 | 278 | $6K |
| V2744 | Tint, photochromatic, per lens | 66 | 64 | $1K |
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | 64 | 64 | $825.69 |
| V2104 | Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens | 12 | 12 | $161.00 |