Provider Demographics
NPI:1548232218
Name:MAYNARD, RALPH W III (OD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:W
Last Name:MAYNARD
Suffix:III
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 1:124 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
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1153152W00000X
SC778152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909561Medicaid
NC8909561Medicaid
NC410032831Medicare PIN
NC246064AMedicare PIN