Provider Demographics
NPI:1700653789
Name:MAHAFFEY, JILLIAN E (LDO)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:E
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CHAMBER DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2516
Mailing Address - Country:US
Mailing Address - Phone:513-248-4291
Mailing Address - Fax:513-248-4296
Practice Address - Street 1:201 CHAMBER DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-2516
Practice Address - Country:US
Practice Address - Phone:513-248-4291
Practice Address - Fax:513-248-4296
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.012150-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician