Provider Demographics
NPI:1356403919
Name:CAREN LYNN WEISZ
Entity type:Organization
Organization Name:CAREN LYNN WEISZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAREN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WEISZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-744-6735
Mailing Address - Street 1:1520 ROCK RUN DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-3153
Mailing Address - Country:US
Mailing Address - Phone:815-744-6735
Mailing Address - Fax:815-744-6703
Practice Address - Street 1:1520 ROCK RUN DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-3153
Practice Address - Country:US
Practice Address - Phone:815-744-6735
Practice Address - Fax:815-744-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03574OtherSPECTERA
IL115683OtherEYEMED
IL3120OtherDAVIS VISION
IL3120OtherDAVIS VISION