Provider Demographics
NPI:1205046307
Name:OPTICA 2000 INC.
Entity type:Organization
Organization Name:OPTICA 2000 INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-942-0407
Mailing Address - Street 1:819 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5102
Mailing Address - Country:US
Mailing Address - Phone:312-942-0407
Mailing Address - Fax:312-942-0741
Practice Address - Street 1:819 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5102
Practice Address - Country:US
Practice Address - Phone:312-942-0407
Practice Address - Fax:312-942-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204202Medicare ID - Type Unspecified
ILU93452Medicare UPIN