MEDICARE: GARDNER EYE CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist		OH

General Provider Information

NPI Number	:	1205981370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDNER EYE CARE, INC.

Provider Business Mailing Address
First Line	:	408 CLIFDEN CT
Second Line	:
City	:	SUNBURY
State	:	OH
Zip	:	43074-8566
Country	:	US
Telephone Number	:	740-965-5063
Fax Number	:	740-392-1459

Provider Business Practice Location Address
First Line	:	1558 COSHOCTON AVE
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-5416
Country	:	US
Telephone Number	:	740-392-1456
Fax Number	:	740-392-1459

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. HOPE PATTERSON GARDNER
Credential	:	O.D.
Telephone Number	:	740-965-5063

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/22/2020

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