Individual
DR. JEREMY RUSSELL GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
746 N MAIZE RD STE 100, WICHITA, KS 67212-4571
(316) 665-7647
Mailing address
754 N TOH N HAH TRL, WICHITA, KS 67212-4536
(480) 729-2150
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2117
KS
152W00000X
Optometrist
OPT-002433
AZ
Other
Enumeration date
06/18/2020
Last updated
07/14/2020
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