NPI: 1477993186 · CHICAGO, IL 60064 · Optician · NPI assigned 06/26/2013
| Authorized Official | POWERS, AMY (SPECIALIST, PLAN ENROLLMENT) |
| Parent Organization | WAL-MART STORES INC |
| NPI Enumeration Date | 06/26/2013 |
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 TEXAS LLC | FORT WORTH | TX | $59K |
| 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 | 33 | $746.40 |
| 2021 | 108 | $1K |
| 2022 | 83 | $1K |
| 2023 | 692 | $12K |
| 2024 | 256 | $4K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2025 | Deluxe frame | 391 | 383 | $11K |
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | 374 | 371 | $5K |
| V2020 | Frames, purchases | 169 | 163 | $2K |
| V2784 | Lens, polycarbonate or equal, any index, per lens | 195 | 186 | $646.00 |
| 92004 | Ophthalmological services: medical examination and evaluation, comprehensive, new patient | 12 | 12 | $557.40 |
| V2200 | Sphere, bifocal, plano to plus or minus 4.00d, per lens | 18 | 14 | $288.00 |
| V2103 | Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens | 13 | 13 | $239.00 |