MEDICARE: CODY LYNN DAY LSA / OPA-C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZS0410X	Surgical Technologist	00036	TX

General Provider Information

NPI Number	:	1154384402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY LYNN DAY LSA / OPA-C.

Provider Business Mailing Address
First Line	:	3021 RIDGE RD
Second Line	:	SUITE A231
City	:	ROCKWALL
State	:	TX
Zip	:	75032-5806
Country	:	US
Telephone Number	:	214-507-9306
Fax Number	:

Provider Business Practice Location Address
First Line	:	3021 RIDGE RD
Second Line	:	SUITE A231
City	:	ROCKWALL
State	:	TX
Zip	:	75032-5806
Country	:	US
Telephone Number	:	214-507-9306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	10/21/2015

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