Provider Demographics
NPI:1316144736
Name:STEELE, CODY MICHAEL
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:MICHAEL
Last Name:STEELE
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 1:3813 22ND ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1199
Mailing Address - Country:US
Mailing Address - Phone:806-792-2804
Mailing Address - Fax:806-792-2805
Practice Address - Street 1:3813 22ND ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1199
Practice Address - Country:US
Practice Address - Phone:806-792-2804
Practice Address - Fax:806-792-2805
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0871450001Medicare ID - Type Unspecified