Wal-Mart Stores East, LP
NPI 1104361500ActiveOrganization· Technician/Technologist, Optician· Stoughton, WI
Technician/Technologist, Optician in Stoughton, Wisconsin, registered in NPPES in December 2016, part of Wal-Mart Stores, Inc. The authorized official on file is Kimberly Canonic, Director Of Health Care Contracting.
Overview
| NPI | 1104361500 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Wal-Mart Stores, Inc. |
| NPI issued | Dec 21, 2016 |
| Last updated in NPPES | Oct 28, 2026 |
| Certified by provider | Oct 28, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Technician/Technologist, Optician Primary | 156FX1800X | — | — |
| Eyewear Supplier (Equipment, not the service) | 332H00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Other opticians in Stoughton
- 1588785679
- 1407908254