Provider Demographics
NPI:1861676116
Name:GARDNER OPTICAL
Entity type:Organization
Organization Name:GARDNER OPTICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-437-1315
Mailing Address - Street 1:306 13TH ST
Mailing Address - Street 2:PO BOX 289
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-1335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:306 13TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-1335
Practice Address - Country:US
Practice Address - Phone:814-437-1315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017324OtherDORAL
PA218156OtherUPMC
PA0008872940001Medicaid
PAOP0674OtherEYE-MED
PA393779OtherNVA
PAGA0288639OtherBLUE CROSS BLUE SHIELD
PA0017324OtherDORAL