Basic Information
| Provider Information | |||||||||
| NPI: | 1508465519 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WH IL OPTOMETRY PLLC | ||||||||
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| OtherOrganizationName: | WALMART HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 702 SW 8TH ST # MS 0445 | ||||||||
| Address2: | |||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727160445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792772500 | ||||||||
| FaxNumber: | 4792774331 | ||||||||
| Practice Location | |||||||||
| Address1: | 1715 N. KILPATRICK AVE. | ||||||||
| Address2: | |||||||||
| City: | CHICACO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736876043 | ||||||||
| FaxNumber: | 7732767572 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2020 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | BYNUM | ||||||||
| AuthorizedOfficialFirstName: | AMBER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CAO | ||||||||
| AuthorizedOfficialTelephone: | 4792041258 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/12/2021 | ||||||||
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.