1700942539 NPI number — DR. JOHN J. GARDNER O.D.

Table of content: (NPI 1902884356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700942539 NPI number — DR. JOHN J. GARDNER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDNER
Provider First Name:
JOHN
Provider Middle Name:
J.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700942539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9400 S ROBERTS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKORY HILLS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60457-2326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-598-1322
Provider Business Mailing Address Fax Number:
705-598-0557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9400 S ROBERTS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKORY HILLS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60457-2326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-598-1322
Provider Business Practice Location Address Fax Number:
705-598-0557
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  046-006455 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 363825038 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363825038 . This is a "EYEMED VISION CARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363825038 . This is a "VISION BENEFITSOF AMERICA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363825038T . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 30177 . This is a "MEDICAL EYE SERVICES" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363825038 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0004648784 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363825038 . This is a "UNICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363825038 . This is a "CHRISTIAN BROTHERS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363825038 . This is a "CORESOURCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 6369 . This is a "DAVIS VISION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363825038 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363825038 . This is a "VISION CARE, INC." identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363825038 . This is a "NATIONAL VISION ADMIN." identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363825038 . This is a "ALWAYSCARE BENEFITS, INC." identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363825038 . This is a "BLOCK VISION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363825038 . This is a "CHOICE BENEFITS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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