Provider Demographics
NPI:1780027557
Name:CODY L HOSS O.D. LLC
Entity Type:Organization
Organization Name:CODY L HOSS O.D. LLC
Other - Org Name:HAYSVILLE FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HOSS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-858-4558
Mailing Address - Street 1:1425 W GRAND AVE
Mailing Address - Street 2:111
Mailing Address - City:HAYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67060-1269
Mailing Address - Country:US
Mailing Address - Phone:316-858-4558
Mailing Address - Fax:
Practice Address - Street 1:1425 W GRAND AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:HAYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:67060-1269
Practice Address - Country:US
Practice Address - Phone:316-858-4558
Practice Address - Fax:316-858-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1898152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS6772510001Medicare NSC