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Profile for Costco Wholesale Corporation

Personal Information

Profession: Contact Lens Distributor (CD)

35263 West State Street
Burlington, WI, 53105

Phone: (800) 955 2292

Year of Birth:

  • School Name:
  • Degree Date:

License Information

  • License Number: 75-00029
  • License Type: Active
  • License Status: Current
  • License Expiration Date: 09/27/2023
  • Original License Date: 09/27/2019
  • Last Renewal Date: 10/12/2022
  • Date This Status: 10/12/2022
  • Continuing Education Year:
  • Temporary License Permit Number:
  • Temporary License Permit Issue Date:
  • Temporary License Permit Expiration Date:

Practice Specialty

Specialties and board certifications are for MDs and DOs only and are self-reported. Therefore, they are not independently verified by the Board of Healing Arts.

Other KSBHA Licenses

None Reported

KSBHA Actions

None Reported

Health Care Facility Privilege Actions

None Reported

Other Public License Actions, DEA Actions, Criminal Actions, or Miscellaneous Information

None Reported

Statement from Licensee or Registrant

None Reported

License Profile last updated: November 28, 2022