Provider Demographics
NPI:1235239773
Name:GARDINER, DAVID (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GARDINER
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 1:13201 RANCH ROAD 620 N STE 100 BLDG R
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-1028
Mailing Address - Country:US
Mailing Address - Phone:512-336-2020
Mailing Address - Fax:
Practice Address - Street 1:13201 RANCH ROAD 620 N STE 100 BLDG R
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-1028
Practice Address - Country:US
Practice Address - Phone:512-336-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5125T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5125TOtherSTATE LICENSE
TXW0101075OtherDPS LICENSE
TXW0101075OtherDPS LICENSE
TXMG0462464OtherDEA NUMBER