Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | IL | |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | IN |
NPI | 1013086990 |
---|---|
Provider Name | Dr. David D Dewaard |
First Address | Chicago, IL 60640-5622 |
Second Address | Chicago, IL 60640-5622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
692660 | (02) |