NPI 1902771173

Wal-Mart Stores East , LP

Organisation Optician Broken Arrow, OK

Practice location

Address: 2301 W Kenosha St, Broken Arrow, OK 74012-8912
Phone: (918) 505-6908
Fax: (918) 505-6909
Mailing address: 1 Customer Dr, Bentonville, AR 72716-0445

Authorised official

Name: Kimberly Canonic
Title: Senior Director
Phone: (479) 371-1168

Registered specialties (2)

Optician Primary

Eye and Vision Services Providers Taxonomy 156FX1800X

Other Technician/Technologist providers in Oklahoma →

Eyewear Supplier

Suppliers Taxonomy 332H00000X

Other Eyewear Supplier providers in Oklahoma →

Registry record

NPI: 1902771173
Entity type: Organization
NPI issued: 8 Oct 2025
Record last updated: 8 Oct 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.