MEDICARE: DR. ALAN DAVID WEILER 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		IL

General Provider Information

NPI Number	:	1699755751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN DAVID WEILER O.D.

Provider Business Mailing Address
First Line	:	3500 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1314
Country	:	US
Telephone Number	:	773-327-0874
Fax Number	:	773-327-6535

Provider Business Practice Location Address
First Line	:	3500 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1314
Country	:	US
Telephone Number	:	773-327-0874
Fax Number	:	773-327-6535

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	07/08/2007

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