Healthcare Provider Details

I. General information

NPI: 1447225529
Provider Name (Legal Business Name): RICHARD C WEINSTEIN O.D. LTD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 PENNY AVE SUITE E
EAST DUNDEE IL
60118-1458
US

IV. Provider business mailing address

210 PENNY AVE SUITE E
EAST DUNDEE IL
60118-1458
US

V. Phone/Fax

Practice location:
  • Phone: 847-426-3221
  • Fax: 847-426-3461
Mailing address:
  • Phone: 847-426-3221
  • Fax: 847-426-3461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-6648
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: