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General NPI Number Information
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NPI Number | 1912879321
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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 | 09/23/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 425 W HOLMES ST
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City | CHESTER
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State | IL
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Zip | 62233-1331
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Country | US
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Telephone | 618-826-4521
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Fax | 618-826-4520
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Provider Business Mailing Address
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Address Line | 425 W HOLMES ST
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City | CHESTER
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State | IL
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Zip | 62233-1331
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Country | US
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Telephone | 618-826-4521
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Fax | 618-826-4520
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT POUYAT
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Credential |
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Telephone | 847-395-8885
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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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