Provider Demographics
NPI:1437155868
Name:MAGGARD, MICHAEL L (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:MAGGARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13930 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-4904
Mailing Address - Country:US
Mailing Address - Phone:352-567-8989
Mailing Address - Fax:352-567-0116
Practice Address - Street 1:13930 7TH ST
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4904
Practice Address - Country:US
Practice Address - Phone:352-567-8989
Practice Address - Fax:352-567-0116
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOB 437152W00000X
FLOPC 1762152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL410000386OtherRAILROAD MEDICARE
FL410000386OtherRAILROAD MEDICARE
FL078273400Medicaid
FLT85230Medicare UPIN
1188970001Medicare NSC
FL19707AMedicare PIN