Healthcare Provider Details

I. General information

NPI: 1699755751
Provider Name (Legal Business Name): ALAN DAVID WEILER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 N ASHLAND AVE
CHICAGO IL
60657-1314
US

IV. Provider business mailing address

3500 N ASHLAND AVE
CHICAGO IL
60657-1314
US

V. Phone/Fax

Practice location:
  • Phone: 773-327-0874
  • Fax: 773-327-6535
Mailing address:
  • Phone: 773-327-0874
  • Fax: 773-327-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: