Provider Demographics
NPI:1245299338
Name:CODNER, BILL G (OD)
Entity type:Individual
Prefix:DR
First Name:BILL
Middle Name:G
Last Name:CODNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:477 N EL CAMINO REAL STE C202
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1332
Mailing Address - Country:US
Mailing Address - Phone:760-753-5150
Mailing Address - Fax:760-753-5150
Practice Address - Street 1:477 N EL CAMINO REAL STE C202
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1332
Practice Address - Country:US
Practice Address - Phone:760-753-5150
Practice Address - Fax:760-753-5150
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT110642-8908152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000009649Medicare ID - Type Unspecified
UTT78159Medicare UPIN