Healthcare Provider Details

I. General information

NPI: 1679494082
Provider Name (Legal Business Name): CODY KARTANOWICZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 US HIGHWAY 80 W
DUBLIN GA
31021-0930
US

IV. Provider business mailing address

2423 US HIGHWAY 80 W
DUBLIN GA
31021-0930
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-8703
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberLDO003101
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: