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General NPI Number Information
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NPI Number | 1881278208
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Entity Type | Individual
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Provider Name | JEREMY STEPHEN MAYLATH MD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 87 US-22 #100
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City | MAINEVILLE
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State | OH
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Zip | 45039
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Country | US
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Telephone | 513-984-5133
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 4TH ST RM 2A100
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City | LUBBOCK
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State | TX
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Zip | 79430-0002
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Country | US
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Telephone | 806-743-2020
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 35.153368
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License Number State | OH
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