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General NPI Number Information
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NPI Number | 1295241024
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Entity Type | Individual
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Provider Name | COREY MICHAEL CODDINGTON OD
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Gender | Male
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 2150 CHILI AVE
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City | ROCHESTER
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State | NY
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Zip | 14624-3453
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Country | US
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Telephone | 585-429-9780
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Fax | 585-429-9687
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Provider Business Mailing Address
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Address Line | 5 NOVA LN
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City | ROCHESTER
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State | NY
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Zip | 14606-5807
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Country | US
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Telephone | 585-613-2350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 009794-1
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License Number State | NY
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