MEDICARE: COSTCO WHOLESALE CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1508250838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSTCO WHOLESALE CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 35005
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-3405
Country	:	US
Telephone Number	:	425-313-8100
Fax Number	:	425-313-6922

Provider Business Practice Location Address
First Line	:	3250 VERNON BLVD
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-4927
Country	:	US
Telephone Number	:	718-267-3680
Fax Number	:	718-956-6212

Authorized Official
Title or Position	:	AVP OPTICAL
Name	:	ART SALAS
Credential	:
Telephone Number	:	718-267-5512

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	03/04/2020

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Directions to “COSTCO WHOLESALE CORPORATION ” Practice Location

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