Provider Demographics
NPI:1699755751
Name:WEILER, ALAN DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DAVID
Last Name:WEILER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1314
Mailing Address - Country:US
Mailing Address - Phone:773-327-0874
Mailing Address - Fax:773-327-6535
Practice Address - Street 1:3500 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1314
Practice Address - Country:US
Practice Address - Phone:773-327-0874
Practice Address - Fax:773-327-6535
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL338590Medicare ID - Type Unspecified
ILU47567Medicare UPIN