Provider Demographics
NPI:1669800710
Name:MAKISHA S MAGGARD OD & ASSOCIATES
Entity type:Organization
Organization Name:MAKISHA S MAGGARD OD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MAKISHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAGGARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-967-7806
Mailing Address - Street 1:2160 SIR BARTON WAY
Mailing Address - Street 2:SUITE 143
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2228
Mailing Address - Country:US
Mailing Address - Phone:859-543-0857
Mailing Address - Fax:859-543-0737
Practice Address - Street 1:2160 SIR BARTON WAY
Practice Address - Street 2:SUITE 143
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2228
Practice Address - Country:US
Practice Address - Phone:859-543-0857
Practice Address - Fax:859-543-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1696DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty