Provider Demographics
NPI:1518272905
Name:GARDNER, JANICE M (OD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:M
Last Name:GARDNER
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 1:2374 POST RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2260
Mailing Address - Country:US
Mailing Address - Phone:401-921-0098
Mailing Address - Fax:
Practice Address - Street 1:2374 POST RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2260
Practice Address - Country:US
Practice Address - Phone:401-921-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00548152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist