MEDICARE: NOVA 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	046006455	IL

General Provider Information

NPI Number	:	1306160130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA EYE CARE INC.

Provider Business Mailing Address
First Line	:	931 W 75TH ST
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-1294
Country	:	US
Telephone Number	:	630-357-6662
Fax Number	:	630-357-6687

Provider Business Practice Location Address
First Line	:	931 W 75TH ST
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-1294
Country	:	US
Telephone Number	:	630-357-6662
Fax Number	:	630-357-6687

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN J. GARDNER
Credential	:	O.D.
Telephone Number	:	708-598-1322

Provider Enumeration Date	:	03/23/2010
Last Update Date	:	03/23/2010

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Directions to “NOVA EYE CARE INC. ” Practice Location

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