MEDICARE: CODY WHIDDON INC.

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2E6890	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811186414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CODY WHIDDON INC.

Provider Business Mailing Address
First Line	:	3905 VICTORY DRIVE
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75672-4755
Country	:	US
Telephone Number	:	903-935-2861
Fax Number	:	903-935-1047

Provider Business Practice Location Address
First Line	:	3905 VICTORY DRIVE
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75672-4755
Country	:	US
Telephone Number	:	903-935-2861
Fax Number	:	903-935-1047

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	CODY H WHIDDON
Credential	:	O.D.
Telephone Number	:	903-935-2861

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	08/25/2025

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Directions to “CODY WHIDDON INC. ” Practice Location

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