Provider Demographics
NPI:1811186414
Name:CODY WHIDDON INC.
Entity type:Organization
Organization Name:CODY WHIDDON INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:H
Authorized Official - Last Name:WHIDDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-935-2861
Mailing Address - Street 1:3905 VICTORY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-4755
Mailing Address - Country:US
Mailing Address - Phone:903-935-2861
Mailing Address - Fax:903-935-1047
Practice Address - Street 1:3905 VICTORY DRIVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672-4755
Practice Address - Country:US
Practice Address - Phone:903-935-2861
Practice Address - Fax:903-935-1047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1588143598Medicaid
TX2E6890OtherMEDICARE
TX00E40AMedicare PIN
TX826580620Medicare PIN
TX00Y717Medicare PIN
TXT12967Medicare UPIN