Provider Demographics
NPI:1710377858
Name:COSTCO WHOLESALE CORPORATION
Entity type:Organization
Organization Name:COSTCO WHOLESALE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AVP OPTICAL
Authorized Official - Prefix:
Authorized Official - First Name:ART
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-253-6041
Mailing Address - Street 1:PO BOX 35005
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3405
Mailing Address - Country:US
Mailing Address - Phone:425-313-8100
Mailing Address - Fax:425-313-6922
Practice Address - Street 1:29315 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-2212
Practice Address - Country:US
Practice Address - Phone:951-253-6041
Practice Address - Fax:951-253-6034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COSTCO WHOLESALE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-28
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7185332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier