Healthcare Provider Details

I. General information

NPI: 1316241540
Provider Name (Legal Business Name): OPTICA 2000
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/03/2011
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 TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTONIO PRIETO
Title or Position: OWNER/OPERATOR
Credential:
Phone: 312-942-0407