Healthcare Provider Details

I. General information

NPI: 1659668077
Provider Name (Legal Business Name): VALERIE JO GARDNER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MT AIRYSHIRE BLVD
COLUMBUS OH
43235
US

IV. Provider business mailing address

730 MT AIRYSHIRE BLVD
COLUMBUS OH
43235
US

V. Phone/Fax

Practice location:
  • Phone: 614-880-2020
  • Fax: 614-846-8577
Mailing address:
  • Phone: 614-880-2020
  • Fax: 614-846-8577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6017
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: