Provider Demographics
NPI:1912437369
Name:GARDNER, LAUREN MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:MARIE
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 1:13712 BEAM RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9618
Mailing Address - Country:US
Mailing Address - Phone:217-549-4428
Mailing Address - Fax:
Practice Address - Street 1:10922 E COUNTY ROAD 800 S STE A
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-9161
Practice Address - Country:US
Practice Address - Phone:317-856-2000
Practice Address - Fax:317-856-2005
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004025A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist