MEDICARE: DR. LINDA S WEIL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	468095	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01626808	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1063410033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA S WEIL O.D.

Provider Business Mailing Address
First Line	:	3800 HIGHLAND AVE
Second Line	:	STE. 100
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1557
Country	:	US
Telephone Number	:	630-960-0456
Fax Number	:	630-960-9521

Provider Business Practice Location Address
First Line	:	3800 HIGHLAND AVE
Second Line	:	STE. 100
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1557
Country	:	US
Telephone Number	:	630-960-0456
Fax Number	:	630-960-9521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	10/08/2007

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