Individual
DR. JACOB LEO STALLBAUMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1130 W MADISON ST, CHICAGO, IL 60607-2023
(312) 226-7200
(312) 226-6490
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046011248
IL
152W00000X
Optometrist
3401
TN
Other
Enumeration date
07/21/2017
Last updated
05/20/2024
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