Provider Demographics
NPI:1568502615
Name:GARTNER, JOHN E (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:GARTNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1697 CALLE ALTA
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7105
Mailing Address - Country:US
Mailing Address - Phone:858-273-3919
Mailing Address - Fax:858-273-5021
Practice Address - Street 1:7770 REGENTS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1937
Practice Address - Country:US
Practice Address - Phone:858-546-1940
Practice Address - Fax:858-546-0940
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA08232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0082320Medicaid
CAWY1867Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
CASD0082320Medicaid