MEDICARE: JASON WEUBBE

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	046011683	IL

General Provider Information

NPI Number	:	1467171173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON WEUBBE

Provider Business Mailing Address
First Line	:	4854 N CHRISTIANA AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-8421
Country	:	US
Telephone Number	:	630-995-5573
Fax Number	:	773-944-0202

Provider Business Practice Location Address
First Line	:	4625 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2007
Country	:	US
Telephone Number	:	773-944-1039
Fax Number	:	773-944-0202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2022
Last Update Date	:	01/26/2026

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Directions to “ JASON WEUBBE ” Practice Location

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