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General NPI Number Information
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NPI Number | 1467171173
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Entity Type | Individual
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Provider Name | JASON WEUBBE
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Gender | Male
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Dates
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Enumeration Date | 08/25/2022
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 4625 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2007
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Country | US
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Telephone | 773-944-1039
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Fax | 773-944-0202
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Provider Business Mailing Address
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Address Line | 4854 N CHRISTIANA AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60625-8421
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Country | US
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Telephone | 630-995-5573
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Fax | 773-944-0202
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 046011683
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License Number State | IL
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