Organization · Type 2 NPI

Costco Wholesale Corporation

Eyewear Supplier · Glen Allen, VA

NPI number 1720472079 Active

Practice location

9650 W Broad St
Glen Allen, VA 23060-4115

Call (804) 727-3050 Map

Fax (804) 727-3062

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.

10 other providers at this address

Other eyewear supplier providers in Glen Allen

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NPI record

NPI: 1720472079
Entity type: Organization (Type 2)
Issued: Mar 25, 2015
Last updated: Mar 6, 2020
Status: Active
Subpart: Yes of Costco Wholesale Corporation

Other names

<unavail>
Costco Optical #205 · doing business as
Costco Optical #205 · doing business as

Authorized official

Art Salas
AVP Optical
(804) 273-0937

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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 1720472079

Costco Wholesale Corporation's National Provider Identifier is 1720472079, issued on Mar 25, 2015. The primary taxonomy on file is Eyewear Supplier (332H00000X), and the practice location is in Glen Allen, VA. The record was last updated on Mar 6, 2020.