Healthcare Provider Details

I. General information

NPI: 1013086990
Provider Name (Legal Business Name): DAVID D DEWAARD O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 W WILSON AVE
CHICAGO IL
60640-5622
US

IV. Provider business mailing address

1056 W WILSON AVE
CHICAGO IL
60640-5622
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-5774
  • Fax:
Mailing address:
  • Phone: 773-271-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: