Provider Demographics
NPI:1285037135
Name:HERMAN, MAGGIE A (OD)
Entity Type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:A
Last Name:HERMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2616
Mailing Address - Country:US
Mailing Address - Phone:330-204-6321
Mailing Address - Fax:
Practice Address - Street 1:3265 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3337
Practice Address - Country:US
Practice Address - Phone:330-836-2200
Practice Address - Fax:330-836-2985
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6343152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist