Provider Demographics
NPI:1306160130
Name:NOVA EYE CARE INC.
Entity type:Organization
Organization Name:NOVA EYE CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-598-1322
Mailing Address - Street 1:931 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-1294
Mailing Address - Country:US
Mailing Address - Phone:630-357-6662
Mailing Address - Fax:630-357-6687
Practice Address - Street 1:931 W 75TH ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1294
Practice Address - Country:US
Practice Address - Phone:630-357-6662
Practice Address - Fax:630-357-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty