Provider Demographics
NPI:1992354849
Name:ALVARADO, CODY (OD)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:
Last Name:ALVARADO
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 1:588 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-3803
Mailing Address - Country:US
Mailing Address - Phone:909-205-1856
Mailing Address - Fax:
Practice Address - Street 1:12625 FREDERICK ST STE B10
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5232
Practice Address - Country:US
Practice Address - Phone:951-571-2192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34383TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist