Healthcare Provider Details

I. General information

NPI: 1912879321
Provider Name (Legal Business Name): ONEOPTO IL 1 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W HOLMES ST
CHESTER IL
62233-1331
US

IV. Provider business mailing address

425 W HOLMES ST
CHESTER IL
62233-1331
US

V. Phone/Fax

Practice location:
  • Phone: 618-826-4521
  • Fax: 618-826-4520
Mailing address:
  • Phone: 618-826-4521
  • Fax: 618-826-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT POUYAT
Title or Position: PRESIDENT
Credential:
Phone: 847-395-8885