Provider Demographics
NPI:1700942539
Name:GARDNER, JOHN J (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:GARDNER
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:9400 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-2326
Mailing Address - Country:US
Mailing Address - Phone:708-598-1322
Mailing Address - Fax:705-598-0557
Practice Address - Street 1:9400 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-2326
Practice Address - Country:US
Practice Address - Phone:708-598-1322
Practice Address - Fax:705-598-0557
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL046-006455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363825038OtherCIGNA HEALTH CARE
IL363825038OtherEYEMED VISION CARE
IL363825038OtherVISION BENEFITSOF AMERICA
IL363825038TOtherBLUE CROSS BLUE SHIELD
IL30177OtherMEDICAL EYE SERVICES
IL363825038OtherUNITED HEALTH CARE
IL0004648784OtherAETNA
IL363825038OtherUNICARE
IL363825038OtherCHRISTIAN BROTHERS
IL363825038OtherCORESOURCE
IL6369OtherDAVIS VISION
IL363825038OtherVISION SERVICE PLAN
IL363825038OtherVISION CARE, INC.
IL363825038OtherNATIONAL VISION ADMIN.
IL363825038OtherALWAYSCARE BENEFITS, INC.
IL363825038OtherBLOCK VISION
IL363825038OtherCHOICE BENEFITS
IL363825038OtherVISION CARE, INC.
IL363825038OtherCORESOURCE