Provider Demographics
NPI:1083337489
Name:COWELL, KODY MICHAEL
Entity Type:Individual
Prefix:
First Name:KODY
Middle Name:MICHAEL
Last Name:COWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 E GRANGEVILLE BLVD UNIT 302
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3083
Mailing Address - Country:US
Mailing Address - Phone:805-598-3702
Mailing Address - Fax:
Practice Address - Street 1:1618 E CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-9228
Practice Address - Country:US
Practice Address - Phone:559-737-9690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT35292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist