Active NPI
Philip Leo Gardner, M.D.
- Ophthalmology Physician
- Alameda, CA
National Provider Identifier
1235282252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- A22059
- Practice address
- 2241 Central Ave
Suite a
Alameda, CA 94501-4460 - Phone
- (510) 522-0377
- Fax
- (510) 522-5372
- NPI assigned
- Jan 21, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | A22059 | CA | Primary |
Addresses
Primary practice location
2241 Central Ave
Suite a
Alameda, CA 94501-4460
Mailing address
2241 Central Ave
Suite a
Alameda, CA 94501-4460
Phone (510) 522-0377
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A220590 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A22059 | CA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235282252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2241 CENTRAL AVE",
"address_2": "SUITE A",
"city": "ALAMEDA",
"state": "CA",
"postal_code": "945014460",
"telephone_number": "510-522-0377",
"fax_number": "510-522-5372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2241 CENTRAL AVE",
"address_2": "SUITE A",
"city": "ALAMEDA",
"state": "CA",
"postal_code": "945014460",
"telephone_number": "510-522-0377",
"fax_number": "510-522-5372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "PHILIP",
"middle_name": "LEO",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "CA",
"license": "A22059",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A220590",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Alameda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.