Organization · Type 2 NPI

Costco Wholesale Corporation

Eyewear Supplier · Grand Rapids, MI

NPI number 1417348541 Active

Practice location

5100 28th St SE
Grand Rapids, MI 49512-2049

Call (616) 233-4401 Map

Fax (616) 233-4422

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.

11 other providers at this address

Other eyewear supplier providers in Grand Rapids

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NPI record

NPI: 1417348541
Entity type: Organization (Type 2)
Issued: Feb 11, 2015
Last updated: Feb 26, 2020
Status: Active
Subpart: Yes of Costco Wholesale Corporation

Other names

<unavail>
Costco Optical #784 · doing business as
Costco Optical #784 · doing business as

Authorized official

Art Salas
AVP Optical
(616) 233-4403

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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 1417348541

Costco Wholesale Corporation's National Provider Identifier is 1417348541, issued on Feb 11, 2015. The primary taxonomy on file is Eyewear Supplier (332H00000X), and the practice location is in Grand Rapids, MI. The record was last updated on Feb 26, 2020.