Provider Demographics
NPI:1659668077
Name:GARDNER, VALERIE JO (OD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:JO
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 1:730 MT AIRYSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235
Mailing Address - Country:US
Mailing Address - Phone:614-880-2020
Mailing Address - Fax:614-846-8577
Practice Address - Street 1:730 MT AIRYSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235
Practice Address - Country:US
Practice Address - Phone:614-880-2020
Practice Address - Fax:614-846-8577
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6017152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist