Individual
DR. MIRANDA WOOD MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D
Contact information
Practice address
26 SOUTH MAIN STREET, PONTOTOC, MS 38863-2811
(662) 489-5907
Mailing address
26 SOUTH MAIN STREET, PONTOTOC, MS 38863-2811
(662) 489-5907
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
MS797
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0652140001
CIGNA GOVERNMENT
MS
05
—
09834040
—
MS
01
—
302I413401
MEDICARE INDIVIDUAL PTAN
MS
Enumeration date
12/11/2008
Last updated
10/05/2012
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