WAL-MART STORES TEXAS, LLC
NPI: 1912004375
· TYLER, TX 75707
· Optician
· NPI assigned 09/20/2006
$636.00
Total Medicaid Paid
Provider Details
| Authorized Official | LEVINE, LAURA (MGR GOV CONTRACT) |
| Parent Organization | WAL-MART STORES INC |
| NPI Enumeration Date | 09/20/2006 |
Related Entities
Other providers sharing the same authorized official: LEVINE, LAURA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
12 |
$193.00 |
| 2023 |
25 |
$443.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
25 |
25 |
$417.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$219.00 |