WAL-MART STORES TEXAS LLC
NPI: 1699011338
· LUCAS, TX 75002
· Optician
· NPI assigned 12/28/2012
$773.00
Total Medicaid Paid
Provider Details
| Authorized Official | POWERS, AMY (SPECIALIST, PLAN ENROLLMENT) |
| Parent Organization | WAL-MART STORES INC |
| NPI Enumeration Date | 12/28/2012 |
Related Entities
Other providers sharing the same authorized official: POWERS, AMY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
12 |
$612.00 |
| 2023 |
12 |
$161.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
24 |
24 |
$773.00 |