MEDICARE: ONEOPTO IL 1 PLLC

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

General Provider Information

NPI Number	:	1871465294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONEOPTO IL 1 PLLC

Provider Business Mailing Address
First Line	:	400 W DUNDEE RD STE 14-15
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-3415
Country	:	US
Telephone Number	:	847-459-9119
Fax Number	:	847-459-8115

Provider Business Practice Location Address
First Line	:	400 W DUNDEE RD STE 14-15
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-3415
Country	:	US
Telephone Number	:	847-459-9119
Fax Number	:	847-459-8115

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT POUYAT
Credential	:
Telephone Number	:	847-395-8885

Provider Enumeration Date	:	09/23/2025
Last Update Date	:	09/23/2025

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