Provider Demographics
NPI:1033394267
Name:DR. RALPH W MAYNARD III OD PA
Entity Type:Organization
Organization Name:DR. RALPH W MAYNARD III OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:828-728-5322
Mailing Address - Street 1:124 CEDAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28638-2507
Mailing Address - Country:US
Mailing Address - Phone:828-728-5322
Mailing Address - Fax:828-728-6332
Practice Address - Street 1:124 CEDAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NC
Practice Address - Zip Code:28638-2507
Practice Address - Country:US
Practice Address - Phone:828-728-5322
Practice Address - Fax:828-728-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1153152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909152Medicaid
NC5909152Medicaid
NC0994390001Medicare NSC
NCDN3874Medicare PIN