Provider Demographics
NPI:1164459228
Name:GARDNER, RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:GARDNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 OLD WOODLANDS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1518
Mailing Address - Country:US
Mailing Address - Phone:541-601-7212
Mailing Address - Fax:
Practice Address - Street 1:332 OLD WOODLANDS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1518
Practice Address - Country:US
Practice Address - Phone:541-601-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1240152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist