Healthcare Provider Details

I. General information

NPI: 1205046307
Provider Name (Legal Business Name): OPTICA 2000 INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 N ASHLAND AVE
CHICAGO IL
60622-5102
US

IV. Provider business mailing address

819 N ASHLAND AVE
CHICAGO IL
60622-5102
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-0407
  • Fax: 312-942-0741
Mailing address:
  • Phone: 312-942-0407
  • Fax: 312-942-0741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. DANIEL PRIETO
Title or Position: OWNER
Credential:
Phone: 312-942-0407