Organization · Type 2 NPI

Costco Wholesale Corporation

Eyewear Supplier · Clackamas, OR

NPI number 1093105595 Active

Practice location

13130 SE 84th Ave
Clackamas, OR 97015-9733

Call (503) 794-5500 Map

Fax (503) 786-7906

Mailing address

PO Box 35005
Seattle, WA 98124-3405

Specialties and licenses

Taxonomy	Code	License
Eyewear Supplier Primary	332H00000X	None listed

Eyewear Supplier: An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

9 other providers at this address

Other eyewear supplier providers in Clackamas

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NPI record

NPI: 1093105595
Entity type: Organization (Type 2)
Issued: Feb 4, 2015
Last updated: Feb 20, 2020
Status: Active
Subpart: Yes of Costco Wholesale Corporation

Other names

<unavail>
Costco Optical #97 · doing business as
Costco Optical #97 · doing business as

Authorized official

Art Salas
AVP Optical
(503) 794-5500

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1093105595

Costco Wholesale Corporation's National Provider Identifier is 1093105595, issued on Feb 4, 2015. The primary taxonomy on file is Eyewear Supplier (332H00000X), and the practice location is in Clackamas, OR. The record was last updated on Feb 20, 2020.