Bolingbrook Vision Source Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046006455 Issued in IL

Legal business name

BOLINGBROOK VISION SOURCE INC.

Practice address

492 W Boughton Rd
Bolingbrook, IL 60440-1441

Phone

(630) 759-4396

Fax

(630) 759-7761

NPI assigned

Mar 9, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John J. Gardner, O.D.

Title

Owner

Phone

(708) 598-1322

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher Cullison, O.D.

  • Optometrist
  • Naperville, IL
  • NPI 1871629915
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268092800000",
    "number": "1902129604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "492 W BOUGHTON RD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401441",
            "telephone_number": "630-759-4396",
            "fax_number": "630-759-7761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "492 W BOUGHTON RD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401441",
            "telephone_number": "630-759-4396",
            "fax_number": "630-759-7761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLINGBROOK VISION SOURCE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-09",
        "last_updated": "2010-03-09",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-598-1322",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046006455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Bolingbrook Wellness
• Bolingbrook Womens Clinic S C
• Bollingbrook Urgent Care S.C
• Angela Marie Bolokowicz, CCC-SLP
• Angela Yolanda Bond, MD

• Optometrist in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.