NPIMap

Organization Active NPI

Costco Wholesale Corporation

Doing business as Costco Optical #479

  • Eyewear Supplier
  • Marina del Rey, CA
National Provider Identifier
1053700906
Registry record updated Jun 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
D6455 Issued in CA
Legal business name
COSTCO WHOLESALE CORPORATION
Doing business as
Costco Optical #479
Practice address
13463 Washington Blvd
Marina del Rey, CA 90292-5658
Phone
(310) 754-2001
Fax
(310) 754-2005
NPI assigned
Jan 15, 2015
Last updated
Jun 11, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
COSTCO WHOLESALE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Art Salas
Title
Avp Optical
Phone
(310) 754-2001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X D6455 CA Primary

Addresses

Primary practice location

13463 Washington Blvd
Marina del Rey, CA 90292-5658

Mailing address

PO Box 35005
Seattle, WA 98124-3405
Phone (425) 313-8100

Other names 1

  • Costco Optical #479 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Costco Pharmacy 1391,511 organizations share this tax ID, including this one
Part of
Costco Pharmacy 139

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

13463 Washington Blvd
Marina del Rey, CA 90292
Phone (310) 754-2002

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591833600000",
    "number": "1053700906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35005",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981243405",
            "telephone_number": "425-313-8100",
            "fax_number": "425-313-6922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13463 WASHINGTON BLVD",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902925658",
            "telephone_number": "310-754-2001",
            "fax_number": "310-754-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTCO WHOLESALE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COSTCO WHOLESALE CORPORATION",
        "enumeration_date": "2015-01-15",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A",
        "authorized_official_last_name": "SALAS",
        "authorized_official_first_name": "ART",
        "authorized_official_title_or_position": "AVP OPTICAL",
        "authorized_official_telephone_number": "310-754-2001"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "CA",
            "license": "D6455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Costco Optical #479",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Costco Optical #479",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marina del Rey, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.