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	:	1912601923
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	:

Provider Business Practice Location Address
First Line	:	4816 N 118TH AVE E
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74116-4816
Country	:	US
Telephone Number	:	539-235-5110
Fax Number	:

Authorized Official
Title or Position	:	VP OPTICAL
Name	:	ART SALAS
Credential	:
Telephone Number	:	425-416-5360

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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Directions to “COSTCO WHOLESALE CORPORATION ” Practice Location

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