Healthcare Provider Details

I. General information

NPI: 1639169998
Provider Name (Legal Business Name): RONALD S. WEINGART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 WIESBROOK DRIVE
OSWEGO IL
60543-8312
US

IV. Provider business mailing address

2075 WIESBROOK RD
OSWEGO IL
60543-8312
US

V. Phone/Fax

Practice location:
  • Phone: 630-844-0908
  • Fax: 630-844-0677
Mailing address:
  • Phone: 630-844-0908
  • Fax: 630-844-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-007810
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number046-007810
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number046-007810
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: