MEDICARE: DIVISION OPTICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1396317053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVISION OPTICAL LLC

Provider Business Mailing Address
First Line	:	1756 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7585
Country	:	US
Telephone Number	:	773-489-4848
Fax Number	:

Provider Business Practice Location Address
First Line	:	1756 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7585
Country	:	US
Telephone Number	:	773-489-4848
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	CHRIS FOREIT
Credential	:
Telephone Number	:	773-931-7951

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	07/13/2021

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Directions to “DIVISION OPTICAL LLC ” Practice Location

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