Healthcare Provider Details

I. General information

NPI: 1043628423
Provider Name (Legal Business Name): CHASE SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W WESLEY ST
WHEATON IL
60187-5118
US

IV. Provider business mailing address

127 W WESLEY ST
WHEATON IL
60187-5118
US

V. Phone/Fax

Practice location:
  • Phone: 708-371-5160
  • Fax: 708-930-1844
Mailing address:
  • Phone: 708-371-5160
  • Fax: 708-930-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number01004630
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: