Provider Demographics
NPI:1962553735
Name:BALDWIN-MICKEY, DONNA LYNNE (OD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LYNNE
Last Name:BALDWIN-MICKEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:B
Other - Last Name:ZIGULIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5863 SUMMER PLACE DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-4246
Mailing Address - Country:US
Mailing Address - Phone:419-578-4322
Mailing Address - Fax:
Practice Address - Street 1:5600 MONROE STREET
Practice Address - Street 2:BUILDING A, SUITE 203
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-4356
Practice Address - Country:US
Practice Address - Phone:419-578-4322
Practice Address - Fax:419-517-8285
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4815152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy