Organization
ILYAS OPTICAL INC
Active
Other names
WILSON OPTICAL
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID D DEWAARD O. D. (OWNER/PRESIDENT)
(773) 271-5774
Entity
Organization
Contact information
Practice address
1217 W WILSON AVE, CHICAGO, IL 60640-5516
(773) 271-5774
(773) 271-0741
Mailing address
1217 W WILSON AVE, CHICAGO, IL 60640-5516
(773) 271-5774
(773) 271-0741
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
046007174
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007174
—
IL
Enumeration date
05/14/2008
Last updated
03/29/2023
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