MEDICARE: OPTICAL88 CORP

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	171913	IL

General Provider Information

NPI Number	:	1982147435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTICAL88 CORP

Provider Business Mailing Address
First Line	:	610 W 31ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 W 31ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3023
Country	:	US
Telephone Number	:	312-842-1888
Fax Number	:

Authorized Official
Title or Position	:	OPTICIAN
Name	:	YAYUAN LI
Credential	:
Telephone Number	:	312-842-1888

Provider Enumeration Date	:	11/30/2016
Last Update Date	:	11/30/2016

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Directions to “OPTICAL88 CORP ” Practice Location

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