Provider Demographics
NPI:1821036237
Name:KORSGARDEN, JOSHUA L (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:L
Last Name:KORSGARDEN
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 1:139A GILLETT ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-9323
Mailing Address - Country:US
Mailing Address - Phone:630-650-2041
Mailing Address - Fax:
Practice Address - Street 1:472 N STATE ROUTE 47
Practice Address - Street 2:SUITE E
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-8106
Practice Address - Country:US
Practice Address - Phone:630-650-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL047-930861152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL346-002120OtherCS LICENSE
IL047-930861Medicaid
ILMK1146314OtherDEA
ILMK1146314OtherDEA
IL346-002120OtherCS LICENSE