Active NPI
Costco Wholesale Corporation
Doing business as Costco Optical #1353
- Eyewear Supplier
- Loves Park, IL
National Provider Identifier
1528628955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- Legal business name
- COSTCO WHOLESALE CORPORATION
- Doing business as
- Costco Optical #1353
- Practice address
- 5000 Stadium Drive
Loves Park, IL 61111 - Phone
- (425) 313-8100
- NPI assigned
- Jun 18, 2019
- Last updated
- Feb 26, 2020
- Organization subpart
- Yes
- Parent organization
- COSTCO WHOLESALE CORPORATION
NPPES NPI Registry
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
- (779) 513-8397
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | NU | Primary |
Addresses
Primary practice location
5000 Stadium Drive
Loves Park, IL 61111
Mailing address
PO Box 35005
Seattle, WA 98124-3405
Phone (425) 313-8100
Other names 1
- Costco Optical #1353
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080820000449 | TX | Part B Supplier - Centralized Flu Biller | 4082679451 | This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Part of
- Costco Wholesale Corpor
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560816000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1582675200000",
"number": "1528628955",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 STADIUM DRIVE",
"city": "LOVES PARK",
"state": "IL",
"postal_code": "61111",
"telephone_number": "425-313-8100"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COSTCO WHOLESALE CORPORATION",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COSTCO WHOLESALE CORPORATION",
"enumeration_date": "2019-06-18",
"last_updated": "2020-02-26",
"certification_date": "2020-02-26",
"status": "A",
"authorized_official_last_name": "SALAS",
"authorized_official_first_name": "ART",
"authorized_official_title_or_position": "AVP OPTICAL",
"authorized_official_telephone_number": "779-513-8397"
},
"taxonomies": [
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Costco Optical #1353",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Costco Optical #1353",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Loves Park, IL
- Cornerstone Caregiving East LLC
- Randall B. Correia, M.D.
- Karlo Mark Garcia Corsino
- Costco Wholesale Corporation (Costco Pharmacy #1353)
- Costco Wholesale Corporation (Costco Hearing Aid #1353)
- Theresa Couri, DO
- Christopher Crank
- Crusaders Central Clinic Association (Crusader Community Health)
- Christina M Cruz, M.D.
- Angie Curran, LMT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.