| Buena Vista Optical, P.c. | |
|
6455 S Kedzie Ave Chicago IL 60629-2829 | |
| (773) 863-9234 | |
| (773) 863-9274 |
| Full Name | Buena Vista Optical, P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 6455 S Kedzie Ave, Chicago, Illinois |
| Authorized Official Name and Position | Todd Sims (PRESIDENT) |
| Authorized Official Contact | 7738639234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Buena Vista Optical, P.c. 6455 S Kedzie Ave Chicago IL 60629-2829 Ph: (773) 863-9234 | Buena Vista Optical, P.c. 6455 S Kedzie Ave Chicago IL 60629-2829 Ph: (773) 863-9234 |
| NPI Number | 1740464296 |
|---|---|
| Provider Enumeration Date | 12/19/2007 |
| Last Update Date | 09/11/2013 |
| Medicare PECOS PAC ID | 1951535913 |
|---|---|
| Medicare Enrollment ID | O20131004000282 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740464296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 046-009243 (Illinois) | Primary |
| 332H00000X | Eyewear Supplier | 046-009243 (Illinois) | Secondary |
| Provider Name | Todd W Sims |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1720095532 PECOS PAC ID: 8123252186 Enrollment ID: I20131007000252 |
| Provider Name | Neha Dharia |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1194194100 PECOS PAC ID: 7618279977 Enrollment ID: I20160105000448 |
| Provider Name | Parisa Mobini |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1215253257 PECOS PAC ID: 1456655315 Enrollment ID: I20160212001776 |
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