Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 110642-8908 | UT |
NPI | 1245299338 |
---|---|
Provider Name | Dr. Bill G. Codner |
First Address | Encinitas, CA 92024-1332 |
Second Address | Encinitas, CA 92024-1332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 10/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T78159 | (02) | UT |