Individual
DR. JAY ROSER EBBESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
121 E LOCUST ST, DEKALB, IL 60115-3207
(815) 756-6388
(815) 756-4861
Mailing address
121 E LOCUST ST, DEKALB, IL 60115-3207
(815) 756-6388
(815) 756-4861
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
152W00000X
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046-007326
—
IL
Enumeration date
01/22/2007
Last updated
09/21/2011
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