Individual
MR. CODY MICHAEL BENEDICT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D
Contact information
Practice address
110 EVERGREEN SQ SW, PINE CITY, MN 55063-2000
(320) 629-7262
Mailing address
603 OAK ST W UNIT 1, FREDERIC, WI 54837-8902
(715) 566-4160
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
3652-35
WI
152W00000X
Optometrist
Primary
3756
MN
Other
Enumeration date
11/20/2020
Last updated
02/25/2022
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