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General NPI Number Information
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NPI Number | 1700867652
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Entity Type | Individual
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Provider Name | KYLE D MAYGINNES O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 459 COLEMANS CROSSING BLVD
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City | MARYSVILLE
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State | OH
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Zip | 43040-7068
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Country | US
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Telephone | 937-553-6287
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Fax | 937-707-6933
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Provider Business Mailing Address
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Address Line | 226 FAIRHAVENS
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City | MARYSVILLE
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State | OH
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Zip | 43040-3532
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Country | US
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Telephone | 309-645-2229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 046-008206
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT.007031
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License Number State | OH
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