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WALMART VISION CENTER 30-0928
NPI 1063992378
Technician/Technologist - Optician in Saint Johns, FL

Active since August 16, 2018CLIA 10D2283423 · Waiver
845 DURBIN PAVILION DR, SAINT JOHNS, FL 32259(479) 277-9170 Get Directions Write a Review

NPPES record last updated: August 16, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Walmart Vision Center 30-0928 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WALMART VISION CENTER 30-0928 (NPI 1063992378) is a healthcare organization registered as an optician in Saint Johns, Florida and active in the NPI registry since August 2018. The organization holds a CLIA Waiver certificate valid through June 6, 2027 and lists Sarah Little, Director Of Healthcare Contracting, as its authorized official.

NPPES Registry Identity

NPI1063992378
Entity TypeOrganization
Primary Taxonomy156FX1800X
Legal Business NameWAL-MART STORES EAST , LP
Location Address845 DURBIN PAVILION DRSaint Johns, FL 32259-0000
Mailing Address702 Sw 8th StBentonville, AR 72716-0445 · (479) 277-9170
Phone(479) 277-9170
Organization SubpartNo
Authorized OfficialSarah LittleDirector Of Healthcare Contracting · (479) 277-2500
Enumeration DateAugust 16, 2018
✔ NPI 1063992378 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyTechnician/Technologist · OpticianEye and Vision Services Providers
Taxonomy Code156FX1800X
Definition
Opticians help fit eyeglasses and contact lenses, following prescriptions from Ophthalmologists and Optometrists. They also help customers decide which eyeglass frame or contact lenses to buy.
Also ListedEyewear SupplierTaxonomy 332H00000X
845 DURBIN PAVILION DR, Saint Johns, FL 32259
Open in Google Maps ↗

Other Names 1

Doing Business AsWalmart Vision Center 30-0928

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Louisiana.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2283423

Wal-Mart Stores East LP · Fruit Cove, FL
Active · expires Jun 6, 2027
CLIA Number10D2283423
Laboratory TypePharmacy
Certificate Effective DateJune 7, 2025
Certificate Expiration DateJune 6, 2027
Laboratory DirectorJennifer Marcoux
Laboratory Phone(904) 417-9088
Laboratory LocationWal-Mart Stores East LP445 State Road 13, Fruit Cove, FL 32259
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2189806

Wal-Mart Stores East, LP · St Johns, FL
Expired · Aug 5, 2026
CLIA Number10D2189806
Laboratory TypePrison
Certificate Effective DateAugust 6, 2024
Certificate Expiration DateAugust 5, 2026
Laboratory DirectorJoshua Broadway
Laboratory Phone(904) 417-9675
Laboratory LocationWal-Mart Stores East, LP845 Durbin Pavilion Drive, St Johns, FL 32259
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOSHUA JEFFREY BROADWAY
Pharmacist
845 DURBIN PAVILION DR
ST JOHNS, FL 32259
St. Johns County (904) 417-9675
DAVID ROBERT RAY JR.
Technician/Technologist (Optician)
845 DURBIN PAVILION DR
ST JOHNS, FL 32259
St. Johns County (904) 417-9670
WAL-MART STORES EAST, LP
Pharmacy (Community/Retail Pharmacy)
845 DURBIN PAVILION DR
SAINT JOHNS, FL 32259
St. Johns County (479) 277-9170
DEEPAKKUMAR SHAH
Pharmacist
845 DURBIN PAVILION DR
ST JOHNS, FL 32259
St. Johns County (904) 417-9675

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wal-Mart Stores East , LP's NPI number?

The NPI number for Wal-Mart Stores East , LP is 1063992378. It was assigned to this organization in the NPPES registry on August 16, 2018. The provider is doing business as Walmart Vision Center 30-0928.

Where is Wal-Mart Stores East , LP located?

Wal-Mart Stores East , LP is located at 845 Durbin Pavilion Dr, Saint Johns, FL 32259. The listed phone number is (479) 277-9170.

What is Wal-Mart Stores East , LP's specialty?

The primary specialty registered for this NPI is Technician/Technologist, specializing in Optician, with taxonomy code 156FX1800X.

Does Wal-Mart Stores East , LP hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2283423) is associated with this NPI, valid through June 6, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Wal-Mart Stores East , LP accept?

Health plans from Blue Cross and Blue Shield of Louisiana list Wal-Mart Stores East , LP as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Wal-Mart Stores East , LP was last updated on August 16, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.