Fred and Linda Kodesch, MDS

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ME49056 Issued in FL

Legal business name

FRED AND LINDA KODESCH, MDS

Practice address

4300 Garden St
Titusville, FL 32796-2937

Phone

(321) 267-2001

Fax

(321) 267-0628

NPI assigned

Oct 22, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fred Kodesch, M.D.

Title

Owner

Phone

(321) 267-2001

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Kodesch and Kodesch, MD Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1224633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285545600000",
    "number": "1790937712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 GARDEN ST",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962937",
            "telephone_number": "321-267-2001",
            "fax_number": "321-267-0628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 GARDEN ST",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962937",
            "telephone_number": "321-267-2001",
            "fax_number": "321-267-0628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED AND LINDA KODESCH, MDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-22",
        "last_updated": "2010-09-27",
        "status": "A",
        "authorized_official_last_name": "KODESCH",
        "authorized_official_first_name": "FRED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-267-2001",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": "FL",
            "license": "ME49057",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME49056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044369700",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044227500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kodesch and Kodesch, MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Ophthalmology Physician in Titusville, FL
• Providers in Titusville, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.