MEDICARE: PAUL BARREDA

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	156FX1800X	Optician

General Provider Information

NPI Number	:	1801319538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL BARREDA

Provider Business Mailing Address
First Line	:	3948 W 26TH ST STE 102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3740
Country	:	US
Telephone Number	:	773-542-2020
Fax Number	:	773-542-7050

Provider Business Practice Location Address
First Line	:	3948 W 26TH ST
Second Line	:	SUITE 102
City	:	CHICAGO
State	:	IL
Zip	:	60623-3740
Country	:	US
Telephone Number	:	773-542-2020
Fax Number	:	773-542-7050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2017
Last Update Date	:	07/21/2022

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Directions to “ PAUL BARREDA ” Practice Location

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