Provider Demographics
NPI:1588143598
Name:WHIDDON, CODY HARRIS (OD)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:HARRIS
Last Name:WHIDDON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-4755
Mailing Address - Country:US
Mailing Address - Phone:903-935-2861
Mailing Address - Fax:
Practice Address - Street 1:3905 VICTORY DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672-4755
Practice Address - Country:US
Practice Address - Phone:903-935-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9508TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist