Healthcare Provider Details

I. General information

NPI: 1043605983
Provider Name (Legal Business Name): COSTCO WHOLESALE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 TIOGA AVE
SAND CITY CA
93955-3050
US

IV. Provider business mailing address

PO BOX 35005
SEATTLE WA
98124-3405
US

V. Phone/Fax

Practice location:
  • Phone: 831-899-9991
  • Fax: 831-899-8503
Mailing address:
  • Phone: 425-313-8100
  • Fax: 425-313-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberD6361
License Number StateCA

VIII. Authorized Official

Name: ART SALAS
Title or Position: AVP OPTICAL
Credential:
Phone: 318-999-9918