Basic Information
| Provider Information | |||||||||
| NPI: | 1396388542 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MC DO OPTOMETRY LLC | ||||||||
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| OtherOrganizationName: | WALMART HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 702 SW 8TH ST | ||||||||
| Address2: | |||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727166209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792041258 | ||||||||
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| Practice Location | |||||||||
| Address1: | 448 WEST BELMONT DRIVE | ||||||||
| Address2: | |||||||||
| City: | CALHOUN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307013016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7622046428 | ||||||||
| FaxNumber: | 7066928121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2019 | ||||||||
| LastUpdateDate: | 12/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | DO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7622046428 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.