Provider Demographics
NPI:1639143985
Name:MAYNARD, MILFORD (OD)
Entity type:Individual
Prefix:DR
First Name:MILFORD
Middle Name:
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:MAYNARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:851 N CENTRAL EXPY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8809
Mailing Address - Country:US
Mailing Address - Phone:972-442-8452
Mailing Address - Fax:
Practice Address - Street 1:2665 RED SPRUCE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-6611
Practice Address - Country:US
Practice Address - Phone:214-425-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02194-TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist