Provider Demographics
NPI:1487006656
Name:GARDNER EYE CARE LLC
Entity Type:Organization
Organization Name:GARDNER EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:J CALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-382-5571
Mailing Address - Street 1:305 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-2003
Mailing Address - Country:US
Mailing Address - Phone:334-382-5571
Mailing Address - Fax:334-383-9101
Practice Address - Street 1:846 FORT DALE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3509
Practice Address - Country:US
Practice Address - Phone:334-382-5571
Practice Address - Fax:334-383-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSB80TA787152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7743870001OtherDMERC