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General NPI Number Information
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NPI Number | 1235449075
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Entity Type | Organization
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Legal Business Name | RICHARD C WEINSTEIN OD, LTD
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 06/07/2011
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Provider Practice Location Address
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Address Line | 210 PENNY AVE SUITE E
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City | EAST DUNDEE
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State | IL
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Zip | 60118-1458
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Country | US
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Telephone | 847-426-3221
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Fax | 847-426-3461
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Provider Business Mailing Address
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Address Line | 210 PENNY AVE SUITE E
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City | EAST DUNDEE
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State | IL
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Zip | 60118-1458
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Country | US
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Telephone | 847-426-3221
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Fax | 847-426-3461
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD C WEINSTEIN
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Credential | OD
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Telephone | 847-426-3221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046-6648
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License Number State | IL
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