MEDICARE: OPTICAL 20/20

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332G00000X	Eye Bank	1598291	IL

General Provider Information

NPI Number	:	1588864573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTICAL 20/20

Provider Business Mailing Address
First Line	:	3215 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3215 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3310
Country	:	US
Telephone Number	:	773-522-2501
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARIA E TORRES
Credential	:
Telephone Number	:	773-522-2501

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	07/19/2007

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Directions to “OPTICAL 20/20 ” Practice Location

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