MEDICARE: DR WILLIAM B BRAND S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0466654	IL

General Provider Information

NPI Number	:	1174779318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR WILLIAM B BRAND S.C.

Provider Business Mailing Address
First Line	:	1794 S ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005-3727
Country	:	US
Telephone Number	:	847-640-1211
Fax Number	:	847-640-1218

Provider Business Practice Location Address
First Line	:	1794 S ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005-3727
Country	:	US
Telephone Number	:	847-640-1211
Fax Number	:	847-640-1218

Authorized Official
Title or Position	:	OD/OWNER
Name	:	DR. JASON BRAND
Credential	:	OD
Telephone Number	:	847-640-1211

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	07/15/2019

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