Provider Demographics
NPI:1952633372
Name:MASTERS, CODY BENTON (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:BENTON
Last Name:MASTERS
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 S BRYANT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5803
Mailing Address - Country:US
Mailing Address - Phone:405-341-6588
Mailing Address - Fax:405-348-9537
Practice Address - Street 1:920 S BRYANT AVE STE 101
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5803
Practice Address - Country:US
Practice Address - Phone:405-341-6588
Practice Address - Fax:405-348-9537
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician