Provider Demographics
NPI:1871610071
Name:JOHN J. GARDNER, O.D., P.C.
Entity type:Organization
Organization Name:JOHN J. GARDNER, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST & OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-598-1322
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:708-598-0557
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:708-598-0557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherCIGNA HEALTH CARE
IL=========OtherVISION CARE, INC.
IL=========OtherCORESOURCE
IL=========OtherALWAYS CARE BENEFITS
IL=========OtherCHOICE BENEFITS
IL=========OtherDAVIS VISION
IL=========OtherBLOCK VISION
IL=========OtherNATIONAL VISION ADMIN.
IL=========OtherEYEMED VISION CARE
IL=========TOtherBLUE CROSS BLUE SHIELD
IL=========OtherCHRISTIAN BROTHERS
IL=========OtherUNICARE
IL=========OtherUNITED HEALTH CARE
IL=========OtherVISION SERVICE PLAN
IL=========OtherVISION BENEFITSOF AMERICA
IL=========OtherVISION SERVICE PLAN
ILL28453Medicare PIN
IL=========OtherCORESOURCE