Provider Demographics
NPI:1447225529
Name:WEINSTEIN, RICHARD C (OD LTD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:OD LTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 PENNY AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1458
Mailing Address - Country:US
Mailing Address - Phone:847-426-3221
Mailing Address - Fax:847-426-3461
Practice Address - Street 1:210 PENNY AVE
Practice Address - Street 2:SUITE E
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-1458
Practice Address - Country:US
Practice Address - Phone:847-426-3221
Practice Address - Fax:847-426-3461
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-6648152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL4763001Medicare PIN
ILU17670Medicare UPIN
IL0159810001Medicare NSC