Organization · Type 2 NPI

Costco Wholesale Corporation

Eyewear Supplier · San Bernardino, CA

NPI number 1174912646 Active

Practice location

1099 E Hospitality Ln
San Bernardino, CA 92408-2813

Call (909) 478-3445 Map

Mailing address

PO Box 35005
Seattle, WA 98124-3405

Specialties and licenses

Taxonomy	Code	License
Eyewear Supplier Primary	332H00000X	D4126 (CA)

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

12 other providers at this address

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NPI record

NPI: 1174912646
Entity type: Organization (Type 2)
Issued: Jan 21, 2015
Last updated: Jun 12, 2020
Status: Active
Subpart: Yes of Costco Wholesale Corporation

Other names

<unavail>
Costco Optical #478 · doing business as
Costco Optical #478 · doing business as

Authorized official

Art Salas
AVP Optical
(909) 478-3445

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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 1174912646

Costco Wholesale Corporation's National Provider Identifier is 1174912646, issued on Jan 21, 2015. The primary taxonomy on file is Eyewear Supplier (332H00000X), and the practice location is in San Bernardino, CA. The record was last updated on Jun 12, 2020.