Healthcare Provider Details

I. General information

NPI: 1699159798
Provider Name (Legal Business Name): COSTCO WHOLESALE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 W. INTEGRITY WAY
GRAND CHUTE WI
54913
US

IV. Provider business mailing address

PO BOX 35005
SEATTLE WA
98124-3405
US

V. Phone/Fax

Practice location:
  • Phone: 425-313-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: ART SALAS
Title or Position: AVP OPTICAL
Credential:
Phone: 920-815-4513