Healthcare Provider Details

I. General information

NPI: 1912437369
Provider Name (Legal Business Name): LAUREN MARIE GARDNER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10922 E COUNTY ROAD 800 S STE A
CAMBY IN
46113-9161
US

IV. Provider business mailing address

13712 BEAM RIDGE DR
MCCORDSVILLE IN
46055-9618
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-2000
  • Fax: 317-856-2005
Mailing address:
  • Phone: 217-549-4428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004025A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: