{
"Npi": {
"NPI": "1336539543",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "COSTCO WHOLESALE CORPORATION",
"ParentOrgTIN": null,
"OrgName": "COSTCO WHOLESALE CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 35005",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SEATTLE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98124-3405",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-313-8100",
"MailingAddressFaxNumber": "425-313-6922",
"FirstLinePracticeLocationAddress": "17550 CASTLETON ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CITY OF INDUSTRY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91748-1701",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "626-839-3051",
"PracticeLocationAddressFaxNumber": "626-839-3067",
"EnumerationDate": "01/26/2015",
"LastUpdateDate": "06/12/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SALAS",
"AuthorizedOfficialFirstName": "ART",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "AVP OPTICAL",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "626-839-3051",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "D6757",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}