Provider Demographics
NPI:1518311901
Name:GIRARDEAU, AYNSLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:AYNSLEY
Middle Name:
Last Name:GIRARDEAU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 TUTOR STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227
Mailing Address - Country:US
Mailing Address - Phone:704-937-1444
Mailing Address - Fax:
Practice Address - Street 1:7014 TUTOR STREET
Practice Address - Street 2:SUITE C
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227
Practice Address - Country:US
Practice Address - Phone:704-937-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2442152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist