Provider Demographics
NPI:1700867652
Name:MAYGINNES, KYLE D (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:D
Last Name:MAYGINNES
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 1:226 FAIRHAVENS
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-3532
Mailing Address - Country:US
Mailing Address - Phone:309-645-2229
Mailing Address - Fax:
Practice Address - Street 1:1584 STRINGTOWN RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9832
Practice Address - Country:US
Practice Address - Phone:614-871-4016
Practice Address - Fax:614-871-4073
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008206152W00000X
OHOPT.007031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008206Medicaid
U16529Medicare UPIN
IL046008206Medicaid