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General NPI Number Information
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NPI Number | 1841165131
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Entity Type | Organization
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Legal Business Name | ONEOPTO IL 1, PLLC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 209 S LASALLE ST SUITE 120
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City | CHICAGO
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State | IL
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Zip | 60604
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Country | US
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Telephone | 312-819-2655
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Fax | 312-332-5970
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Provider Business Mailing Address
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Address Line | 209 S LASALLE ST SUITE 120
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City | CHICAGO
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State | IL
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Zip | 60604
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Country | US
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Telephone | 312-819-2655
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Fax | 312-332-5970
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT POUIYAT
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Credential |
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Telephone | 847-997-1477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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