Organization · Type 2 NPI

Costco Wholesale Corporation

Eyewear Supplier · Avondale, AZ

NPI number 1104216258 Active

Practice location

10000 W Mcdowell Rd
Avondale, AZ 85392-4803

Call (623) 907-5661 Map

Fax (623) 907-5680

Mailing address

PO Box 35005
Seattle, WA 98124-3405

Specialties and licenses

Taxonomy	Code	License
Eyewear Supplier Primary	332H00000X	942E (AZ)

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

8 other providers at this address

Other eyewear supplier providers in Avondale

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NPI record

NPI: 1104216258
Entity type: Organization (Type 2)
Issued: Jan 28, 2015
Last updated: Jun 11, 2020
Status: Active
Subpart: Yes of Costco Wholesale Corporation

Other names

<unavail>
Costco Optical #691 · doing business as
Costco Optical #691 · doing business as

Authorized official

Art Salas
AVP Optical
(623) 907-5661

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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 1104216258

Costco Wholesale Corporation's National Provider Identifier is 1104216258, issued on Jan 28, 2015. The primary taxonomy on file is Eyewear Supplier (332H00000X), and the practice location is in Avondale, AZ. The record was last updated on Jun 11, 2020.