Provider Demographics
NPI:1124180781
Name:WEISZ, CAREN LYNN (MED, OD)
Entity Type:Individual
Prefix:DR
First Name:CAREN
Middle Name:LYNN
Last Name:WEISZ
Suffix:
Gender:F
Credentials:MED, OD
Other - Prefix:DR
Other - First Name:CAREN
Other - Middle Name:LYNN
Other - Last Name:WEISZ-GREENSPAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, OD
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1520 N ROCK RUN DR STE 2
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-3172
Practice Address - Country:US
Practice Address - Phone:815-744-6735
Practice Address - Fax:815-744-6703
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007035152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03574OtherSPECTERA
IL115683OtherEYEMED
IL046007035Medicaid
IL3120OtherDAVIS VISION
IL3120OtherDAVIS VISION