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Michael Edward Koditek, O.D.

Optometrist in Frederick, CO. Individual provider (NPI-1).

NPI number1366735201
StatusActive
Last updated in NPPESMar 13, 2020

Details

NPI
1366735201
Entity type
Individual (NPI-1)
Name
Mr. Michael Edward Koditek
Credential
O.D.
Sex
Male
Sole proprietor
Yes
Enumeration date
May 25, 2011
Certification date
Mar 13, 2020
Last updated
Mar 13, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
152W00000X Optometrist2850COYes

Practice location

5900 Keyes St Ste 101
Frederick, CO 80504-5956

Phone 303-833-1056 · Fax 303-833-1057

Mailing address

5900 Keyes St Ste 101
Frederick, CO 80504-5956

Phone 303-833-1056 · Fax 303-833-1057

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