Organization · Type 2 NPI

Costco Wholesale Corporation

Eyewear Supplier · Santa Rosa, CA

NPI number 1619367307 Active

Practice location

1900 Santa Rosa Ave
Santa Rosa, CA 95407-7621

Call (707) 578-7497 Map

Fax (707) 566-6422

Mailing address

PO Box 35005
Seattle, WA 98124-3405

Specialties and licenses

Taxonomy	Code	License
Eyewear Supplier Primary	332H00000X	D6121 (CA)

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 Santa Rosa

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NPI record

NPI: 1619367307
Entity type: Organization (Type 2)
Issued: Feb 2, 2015
Last updated: Jun 5, 2020
Status: Active
Subpart: Yes of Costco Wholesale Corporation

Other names

<unavail>
Costco Optical #41 · doing business as
Costco Optical #41 · doing business as

Authorized official

Art Salas
AVP Optical
(707) 578-7497

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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 1619367307

Costco Wholesale Corporation's National Provider Identifier is 1619367307, issued on Feb 2, 2015. The primary taxonomy on file is Eyewear Supplier (332H00000X), and the practice location is in Santa Rosa, CA. The record was last updated on Jun 5, 2020.