MEDICARE: CAROL LYN G ORDYNSKY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	743T	AZ

General Provider Information

NPI Number	:	1659537330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL LYN G ORDYNSKY O.D.

Provider Business Mailing Address
First Line	:	11103 WEST AVE
Second Line	:	STE 6
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1370
Country	:	US
Telephone Number	:	210-524-6803
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	7000 E MAYO BLVD
Second Line	:	SPACE A
City	:	PHOENIX
State	:	AZ
Zip	:	85054-6151
Country	:	US
Telephone Number	:	480-513-3106
Fax Number	:	480-515-6247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	08/01/2008

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