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General NPI Number Information
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NPI Number | 1417330101
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Entity Type | Individual
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Provider Name | CODY PATTERSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 623 E MATTHEWS AVE STE A
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City | JONESBORO
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State | AR
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Zip | 72401-3145
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Country | US
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Telephone | 870-932-2211
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Fax | 870-972-5152
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Provider Business Mailing Address
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Address Line | 1815 E HIGHLAND DR
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City | JONESBORO
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State | AR
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Zip | 72401-6118
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Country | US
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Telephone | 870-931-2020
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Fax | 870-932-8004
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2723
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License Number State | AR
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