WAL-MART STORE TEXAS, LLC
NPI: 1548391089
· PFLUGERVILLE, TX 78660
· Optician
· NPI assigned 03/08/2007
$204K
Total Medicaid Paid
Provider Details
| Authorized Official | LEVINE, LAURA (MANAGER, GOV'T CONTRACTING) |
| Parent Organization | WAL-MART STORES, INC |
| NPI Enumeration Date | 03/08/2007 |
Related Entities
Other providers sharing the same authorized official: LEVINE, LAURA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
165 |
$6K |
| 2021 |
1,437 |
$56K |
| 2022 |
1,241 |
$52K |
| 2023 |
1,478 |
$65K |
| 2024 |
604 |
$25K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,531 |
1,082 |
$93K |
| V2025 |
Deluxe frame |
827 |
826 |
$64K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,295 |
1,275 |
$25K |
| V2750 |
Anti-reflective coating, per lens |
1,039 |
1,028 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
164 |
163 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
69 |
69 |
$1K |