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General NPI Number Information
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NPI Number | 1306029384
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Entity Type | Organization
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Legal Business Name | DR TODD M MAYNARD PSC
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 64 KIRK PLAZA
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City | INEZ
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State | KY
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Zip | 41224-1307
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Country | US
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Telephone | 606-298-7768
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Fax | 606-298-4839
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Provider Business Mailing Address
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Address Line | PO BOX 1307
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City | INEZ
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State | KY
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Zip | 41224-1307
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Country | US
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Telephone | 606-298-7768
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Fax | 606-298-4839
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Authorized Official
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Title or Position | PRESIDENT
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Name | TODD MAYNARD
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Credential | O.D.
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Telephone | 606-298-7768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1295DT
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License Number State | KY
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