MEDICARE: BIG CITY 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	046009691	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568900140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIG CITY OPTICAL LLC

Provider Business Mailing Address
First Line	:	PO BOX 16974
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-0980
Country	:	US
Telephone Number	:	815-483-9504
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 W 18TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3148
Country	:	US
Telephone Number	:	815-483-9504
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. VYTAUTAS TAMULIS
Credential	:
Telephone Number	:	815-483-9504

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	03/17/2017

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Directions to “BIG CITY OPTICAL LLC ” Practice Location

Language	Start Address	Practice Location

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