# BUENA VISTA OPTICAL, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740464296
- **Authorized official:** DR. TODD SIMS O.D. (PRESIDENT)
- **Authorized official phone:** (773) 863-9234

## Contact information

- **Practice address:** 6455 S KEDZIE AVE, CHICAGO, IL 60629-2829
- **Practice address phone:** (773) 863-9234
- **Practice address fax:** (773) 863-9274
- **Mailing address:** 6455 S KEDZIE AVE, CHICAGO, IL 60629-2829
- **Mailing address phone:** (773) 863-9234
- **Mailing address fax:** (773) 863-9274

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 046-009243 | IL | Yes |
| 332H00000X | Eyewear Supplier | 046-009243 | IL | — |

## Other

- **Enumeration date:** 12/19/2007
- **Last updated:** 09/11/2013