Healthcare Provider Details

I. General information

NPI: 1841165131
Provider Name (Legal Business Name): ONEOPTO IL 1, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S LASALLE ST SUITE 120
CHICAGO IL
60604
US

IV. Provider business mailing address

209 S LASALLE ST SUITE 120
CHICAGO IL
60604
US

V. Phone/Fax

Practice location:
  • Phone: 312-819-2655
  • Fax: 312-332-5970
Mailing address:
  • Phone: 312-819-2655
  • Fax: 312-332-5970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SCOTT POUIYAT
Title or Position: PRESIDENT
Credential:
Phone: 847-997-1477