NPI: 1700219474 · BLOOMINGDALE, IL 60108 · Optician · NPI assigned 08/16/2013
| Authorized Official | POWERS, AMY (SPECIALIST, PLAN ENROLLMENT) |
| Parent Organization | WAL-MART STORES INC |
| NPI Enumeration Date | 08/16/2013 |
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 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 |
|---|---|---|
| 2019 | 112 | $5K |
| 2020 | 94 | $6K |
| 2022 | 26 | $637.00 |
| 2023 | 1,035 | $26K |
| 2024 | 896 | $24K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2020 | Frames, purchases | 997 | 996 | $32K |
| V2103 | Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens | 600 | 580 | $13K |
| V2025 | Deluxe frame | 133 | 108 | $10K |
| V2784 | Lens, polycarbonate or equal, any index, per lens | 323 | 323 | $4K |
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | 96 | 96 | $2K |
| V2104 | Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens | 14 | 14 | $219.00 |