Provider Demographics
NPI:1538778097
Name:OPT VISION
Entity type:Organization
Organization Name:OPT VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:SZWAJCA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-890-3172
Mailing Address - Street 1:111 S PEORIA ST UNIT 307
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2883
Mailing Address - Country:US
Mailing Address - Phone:847-890-3172
Mailing Address - Fax:
Practice Address - Street 1:5371 W LAWRENCE AVE STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3695
Practice Address - Country:US
Practice Address - Phone:847-890-3172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty