Provider Demographics
NPI:1649687534
Name:BREITHAUPT, AUBREY DYL (OD)
Entity type:Individual
Prefix:DR
First Name:AUBREY
Middle Name:DYL
Last Name:BREITHAUPT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AUBREY
Other - Middle Name:MARIE
Other - Last Name:DYL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3241 S MICHIGAN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3878
Mailing Address - Country:US
Mailing Address - Phone:312-225-6200
Mailing Address - Fax:312-949-7617
Practice Address - Street 1:3241 S MICHIGAN AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3878
Practice Address - Country:US
Practice Address - Phone:312-225-6200
Practice Address - Fax:312-949-7617
Is Sole Proprietor?:No
Enumeration Date:2014-07-13
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8670T152W00000X, 152WP0200X, 152WV0400X
MI4901004831152WP0200X, 152WV0400X
IL046011759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy