Provider Demographics
NPI:1750253167
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:POUYAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-395-8885
Mailing Address - Street 1:520 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-1889
Mailing Address - Country:US
Mailing Address - Phone:618-443-5252
Mailing Address - Fax:618-443-2350
Practice Address - Street 1:520 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-1889
Practice Address - Country:US
Practice Address - Phone:618-443-5252
Practice Address - Fax:618-443-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty