Provider Demographics
NPI:1598917965
Name:BRAND, JASON EVAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:EVAN
Last Name:BRAND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:361 SATINWOOD CT S
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6612
Mailing Address - Country:US
Mailing Address - Phone:847-989-1723
Mailing Address - Fax:
Practice Address - Street 1:2240 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3103
Practice Address - Country:US
Practice Address - Phone:815-756-8571
Practice Address - Fax:815-756-5603
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009483152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU92372Medicare UPIN