MEDICARE: SOLO EYE CARE BRIDGEPORT 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
2	152WC0802X	Corneal and Contact Management Optometrist

General Provider Information

NPI Number	:	1962973503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLO EYE CARE BRIDGEPORT PLLC

Provider Business Mailing Address
First Line	:	3460 S HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-6743
Country	:	US
Telephone Number	:	312-225-5135
Fax Number	:	312-225-5309

Provider Business Practice Location Address
First Line	:	3460 S HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-6743
Country	:	US
Telephone Number	:	313-225-5135
Fax Number	:	312-225-5309

Authorized Official
Title or Position	:	ADMIN
Name	:	LAUREN SULLIVAN
Credential	:
Telephone Number	:	312-588-5999

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	02/17/2026

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