Bolingbrook Vision Source Inc.

Optometrist · Bolingbrook, IL

Organization Active NPI

NPI number 1902129604

Practice location

492 W Boughton Rd
Bolingbrook, IL 60440-1441
Phone
(630) 759-4396
Fax
(630) 759-7761

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NPI record

NPI
1902129604
Entity type
Organization (Type 2)
Enumeration date
March 9, 2010
Last updated
March 9, 2010
Organization subpart
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Optometrist Primary 152W00000X 046006455 IL

Authorized official

Name
Dr. John J. Gardner, O.D.
Title
Owner
Phone
(708) 598-1322

About Bolingbrook Vision Source Inc.

Bolingbrook Vision Source Inc. is a healthcare organization registered in the NPI registry with the primary taxonomy Optometrist (code 152W00000X). The practice location is 492 W Boughton Rd, Bolingbrook, IL 60440-1441. The NPI number 1902129604 was assigned on March 9, 2010 and the record was last updated on March 9, 2010.

Bolingbrook Vision Source Inc. lists a license in the registry: #046006455 (IL) for Optometrist. License numbers are self-reported to NPPES; verify them with the state licensing board.

The authorized official for this organization is Dr. John J. Gardner, O.D., Owner.

Frequently asked questions

What is the NPI number of Bolingbrook Vision Source Inc.?

The NPI number is 1902129604.

What is the phone number of Bolingbrook Vision Source Inc.?

The phone number listed for the practice location is (630) 759-4396.

Where is Bolingbrook Vision Source Inc. located?

492 W Boughton Rd, Bolingbrook, IL 60440-1441.

What is the taxonomy code for Bolingbrook Vision Source Inc.?

The primary taxonomy code is 152W00000X – Optometrist.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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