Healthcare Provider Details

I. General information

NPI: 1194850388
Provider Name (Legal Business Name): JOHN BUCKNER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6757 W NEWBERRY RD
GAINESVILLE FL
32605
US

IV. Provider business mailing address

6757 W NEWBERRY RD
GAINESVILLE FL
32605
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-2040
  • Fax: 352-331-1526
Mailing address:
  • Phone: 352-331-2040
  • Fax: 352-331-1526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: