1962553735 NPI number — DR. DONNA LYNNE BALDWIN-MICKEY O.D.

Table of content: DR. DONNA LYNNE BALDWIN-MICKEY O.D. (NPI 1962553735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962553735 NPI number — DR. DONNA LYNNE BALDWIN-MICKEY O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALDWIN-MICKEY
Provider First Name:
DONNA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZIGULIS
Provider Other First Name:
DONNA
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962553735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5863 SUMMER PLACE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLVANIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43560-4246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-578-4322
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 MONROE STREET
Provider Second Line Business Practice Location Address:
BUILDING A, SUITE 203
Provider Business Practice Location Address City Name:
SYLVANIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43560-4356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-578-4322
Provider Business Practice Location Address Fax Number:
419-517-8285
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152WV0400X , with the licence number:  4815 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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