Healthcare Provider Details

I. General information

NPI: 1316098148
Provider Name (Legal Business Name): WILLIAM B BRAND OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1794 S ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60005-3727
US

IV. Provider business mailing address

1794 S ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60005-3727
US

V. Phone/Fax

Practice location:
  • Phone: 847-640-1211
  • Fax: 847-640-1218
Mailing address:
  • Phone: 847-640-1211
  • Fax: 847-640-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0466654
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: