WAL-MART STORES TEXAS, LLC
NPI: 1700969805
· HUDSON OAKS, TX 76087
· Optician
· NPI assigned 10/23/2006
$908.00
Total Medicaid Paid
Provider Details
| Authorized Official | LEVINE, LAURA (MGR GOV CONTRACTING) |
| Parent Organization | WAL-MART STORES INC |
| NPI Enumeration Date | 10/23/2006 |
Related Entities
Other providers sharing the same authorized official: LEVINE, LAURA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
54 |
$908.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
35 |
33 |
$556.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
19 |
18 |
$352.00 |