MEDICARE: TRAVIS PARK O.D.

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	152W00000X	Optometrist	13586	CA
2	152W00000X	Optometrist	046010179	IL

General Provider Information

NPI Number	:	1689830275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS PARK O.D.

Provider Business Mailing Address
First Line	:	1756 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7585
Country	:	US
Telephone Number	:	773-489-4848
Fax Number	:	773-489-4848

Provider Business Practice Location Address
First Line	:	1756 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7585
Country	:	US
Telephone Number	:	773-489-4848
Fax Number	:	773-489-0808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2008
Last Update Date	:	04/19/2012

Similar Medicare Providers

1396317053 — DIVISION OPTICAL LLC
Practice Location Address:

1756 W DIVISION ST
CHICAGO, IL
60622-7585

Practice Phone: 773-489-4848
Practice Fax:

1033630959 — DR. APRIL BJV CRAWFORD PSYD
Practice Location Address:

150 N MICHIGAN AVE STE 800
CHICAGO, IL
60601-7585

Practice Phone: 312-566-8536
Practice Fax:

1528650736 — STEPHANIE NICHOLE QUINT MS, RD, LDN, CHES
Practice Location Address:

1640 W DIVISION ST
CHICAGO, IL
60622-3939

Practice Phone: 855-552-5557
Practice Fax:

1861329047 — DOMINIC M BRANCH LSW
Practice Location Address:

2930 W GRAND AVE
CHICAGO, IL
60622-4308

Practice Phone: 872-817-9858
Practice Fax:

1174143515 — LEO LEASE
Practice Location Address:

1405 N ARTESIAN AVE # 2
CHICAGO, IL
60622-1704

Practice Phone: 614-915-7182
Practice Fax:

1386571396 — MRS. ERIKA M PEREZ HERRICK LSW
Practice Location Address:

2930 W GRAND AVE
CHICAGO, IL
60622-4308

Practice Phone: 872-817-9858
Practice Fax: 773-661-6993

Directions to “ TRAVIS PARK O.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.