MEDICARE: DR. CODY HARRIS WHIDDON OD

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	152W00000X	Optometrist	9508TG	TX

General Provider Information

NPI Number	:	1588143598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CODY HARRIS WHIDDON OD

Provider Business Mailing Address
First Line	:	3905 VICTORY DR
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75672-4755
Country	:	US
Telephone Number	:	903-935-2861
Fax Number	:

Provider Business Practice Location Address
First Line	:	3905 VICTORY DR
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75672-4755
Country	:	US
Telephone Number	:	903-935-2861
Fax Number	:

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

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	08/25/2025

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