Provider Demographics
NPI:1124249818
Name:CODD, F. NICHOLAS
Entity type:Individual
Prefix:MR
First Name:F.
Middle Name:NICHOLAS
Last Name:CODD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-0627
Mailing Address - Country:US
Mailing Address - Phone:410-647-4924
Mailing Address - Fax:410-647-3239
Practice Address - Street 1:670 RITCHIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3979
Practice Address - Country:US
Practice Address - Phone:410-647-4924
Practice Address - Fax:410-647-3239
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02164910156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0202840001Medicare NSC