Provider Demographics
NPI:1407960008
Name:ROBERT J MAYNARD OD PC
Entity Type:Organization
Organization Name:ROBERT J MAYNARD OD PC
Other - Org Name:KAPLAN & MAYNARD, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:SR
Authorized Official - Credentials:OD
Authorized Official - Phone:602-264-4104
Mailing Address - Street 1:114 W CAMELBACK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-2563
Mailing Address - Country:US
Mailing Address - Phone:602-264-4104
Mailing Address - Fax:602-241-0687
Practice Address - Street 1:114 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-2563
Practice Address - Country:US
Practice Address - Phone:602-264-4104
Practice Address - Fax:602-241-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZZOD145152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT76896Medicare UPIN
AZZOD145Medicare ID - Type Unspecified