Healthcare Provider Details

I. General information

NPI: 1053837435
Provider Name (Legal Business Name): AYNSLEY GIRARDEAU OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7014 TUTOR STREET
MINT HILL NC
28227
US

IV. Provider business mailing address

7014 TUTOR STREET SUITE C
MINT HILL NC
28227
US

V. Phone/Fax

Practice location:
  • Phone: 704-937-1444
  • Fax:
Mailing address:
  • Phone: 704-937-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2442
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2442
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2442
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. AYNSLEY GIRARDEAU
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 704-937-1444