Individual
DR. ROBERT JACK MAYNARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
114 W CAMELBACK RD, SUITE 1, PHOENIX, AZ 85013-2563
(602) 264-4104
(602) 241-0687
Mailing address
114 W CAMELBACK RD, SUITE 1, PHOENIX, AZ 85013-2563
(602) 264-4104
(602) 241-0687
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
145
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
860292404
TAX ID
AZ
01
—
AZ0170990
BLUE CROSS BLUE SHIELD ID
AZ
Enumeration date
01/03/2006
Last updated
01/16/2008
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