WAL-MART STORES EAST, LP
NPI: 1477938025
· HARTFORD, WI 53027
· Optician
· NPI assigned 07/24/2015
$476.00
Total Medicaid Paid
Provider Details
| Authorized Official | LAUVER, DEB (SPECIALIST PLAN ENROLLMENT) |
| Parent Organization | WAL-MART STORES, INC |
| NPI Enumeration Date | 07/24/2015 |
Related Entities
Other providers sharing the same authorized official: LAUVER, DEB
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
42 |
$288.00 |
| 2024 |
26 |
$188.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
28 |
28 |
$476.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
26 |
13 |
$0.00 |
| 92015 |
Determination of refractive state |
14 |
13 |
$0.00 |