MEDICARE: CODY MACKENZIE ABOC

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	156FX1800X	Optician	237912	MN

General Provider Information

NPI Number	:	1679257398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY MACKENZIE ABOC

Provider Business Mailing Address
First Line	:	506 7TH ST W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-3049
Country	:	US
Telephone Number	:	651-333-4420
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 7TH ST W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-3049
Country	:	US
Telephone Number	:	651-333-4420
Fax Number	:

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

Provider Enumeration Date	:	06/13/2023
Last Update Date	:	06/13/2023

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Directions to “ CODY MACKENZIE ABOC” Practice Location

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