Individual
CODY MACKENZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ABOC
Contact information
Practice address
506 7TH ST W, SAINT PAUL, MN 55102-3049
(651) 333-4420
Mailing address
506 7TH ST W, SAINT PAUL, MN 55102-3049
(651) 333-4420
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
237912
MN
Other
Enumeration date
06/13/2023
Last updated
06/13/2023
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