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General NPI Number Information
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NPI Number | 1962553735
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Entity Type | Individual
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Provider Name | DONNA LYNNE BALDWIN-MICKEY O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 5600 MONROE STREET BUILDING A, SUITE 203
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City | SYLVANIA
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State | OH
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Zip | 43560-4356
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Country | US
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Telephone | 419-578-4322
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Fax | 419-517-8285
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Provider Business Mailing Address
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Address Line | 5863 SUMMER PLACE DR
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City | SYLVANIA
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State | OH
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Zip | 43560-4246
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Country | US
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Telephone | 419-578-4322
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 4815
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License Number State | OH
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