Provider Demographics
NPI:1831270008
Name:WYSSMAN, WILLIAM H (OD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:WYSSMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 FINLEY RD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1042
Mailing Address - Country:US
Mailing Address - Phone:630-916-4770
Mailing Address - Fax:
Practice Address - Street 1:2934 FINLEY RD
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1042
Practice Address - Country:US
Practice Address - Phone:630-916-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009206152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist