Provider Demographics
NPI:1770781916
Name:MAGGARD, MAKISHA S (OD)
Entity type:Individual
Prefix:
First Name:MAKISHA
Middle Name:S
Last Name:MAGGARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MAKISHA
Other - Middle Name:S
Other - Last Name:STAMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4051 NICHOLASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-4433
Mailing Address - Country:US
Mailing Address - Phone:859-272-1422
Mailing Address - Fax:859-273-4582
Practice Address - Street 1:2716 OLD ROSEBUD RD STE 130
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8007
Practice Address - Country:US
Practice Address - Phone:859-327-3701
Practice Address - Fax:859-327-3703
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1696DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000537138OtherBLUE CROSS BLUE SHIELD
KY7100013820Medicaid
KY0960205Medicare PIN