Organization · Type 2 NPI

Costco Wholesale Corporation

Eyewear Supplier · East Peoria, IL

NPI number 1396136149 Active

Practice location

301 W Washington St
East Peoria, IL 61611-2036

Call (309) 427-2930 Map

Fax (309) 427-2941

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

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NPI record

NPI: 1396136149
Entity type: Organization (Type 2)
Issued: Feb 16, 2015
Last updated: Feb 27, 2020
Status: Active
Subpart: Yes of Costco Wholesale Corporation

Other names

<unavail>
Costco Optical #1126 · doing business as
Costco Optical #1126 · doing business as

Authorized official

Art Salas
AVP Optical
(309) 427-2943

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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 1396136149

Costco Wholesale Corporation's National Provider Identifier is 1396136149, issued on Feb 16, 2015. The primary taxonomy on file is Eyewear Supplier (332H00000X), and the practice location is in East Peoria, IL. The record was last updated on Feb 27, 2020.