Provider Demographics
NPI:1841165131
Name:ONEOPTO IL 1, PLLC
Entity type:Organization
Organization Name:ONEOPTO IL 1, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:POUIYAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-997-1477
Mailing Address - Street 1:209 S LASALLE ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604
Mailing Address - Country:US
Mailing Address - Phone:312-819-2655
Mailing Address - Fax:312-332-5970
Practice Address - Street 1:209 S LASALLE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604
Practice Address - Country:US
Practice Address - Phone:312-819-2655
Practice Address - Fax:312-332-5970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty