Provider Demographics
NPI:1851524318
Name:BRITO, JUAN I (OD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:I
Last Name:BRITO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 MULLINGAR CT
Mailing Address - Street 2:UNIT 2C
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3264
Mailing Address - Country:US
Mailing Address - Phone:832-721-1349
Mailing Address - Fax:
Practice Address - Street 1:D330 WOODFIELD MALL
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5010
Practice Address - Country:US
Practice Address - Phone:847-619-9470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010282152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist