Healthcare Provider Details

I. General information

NPI: 1659537330
Provider Name (Legal Business Name): CAROL LYN G ORDYNSKY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 E MAYO BLVD SPACE A
PHOENIX AZ
85054-6151
US

IV. Provider business mailing address

11103 WEST AVE STE 6
SAN ANTONIO TX
78213-1370
US

V. Phone/Fax

Practice location:
  • Phone: 480-513-3106
  • Fax: 480-515-6247
Mailing address:
  • Phone: 210-524-6803
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number743T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: