Individual
CODY W DAGNALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
308 W FULTON ST # 1422, WAUPACA, WI 54981-1422
(715) 258-8168
Mailing address
424 S MAIN ST, FALL RIVER, WI 53932-9594
(920) 296-2031
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3809
WI
Other
Enumeration date
05/03/2022
Last updated
09/06/2022
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