Individual provider · NPI-1

Teodoro Carrillo, Optician

Technician/Technologist, Optician · Chicago, IL

NPI number1962528372
StatusActive
Last updated in NPPESFeb 12, 2026

Details

NPI
1962528372
Entity type
Individual (NPI-1)
Name
Mr. Teodoro Carrillo
Credential
Optician
Sex
Male
Sole proprietor
Yes
Enumeration date
Mar 21, 2007
Last updated
Feb 12, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
156FX1800X Technician/Technologist, Optician2511-5278ILYes

Practice location

4610 N Lincoln Ave
Chicago, IL 60625-2008

Phone 773-561-0870 · Fax 773-561-4185

Mailing address

4610 N Lincoln Ave
Chicago, IL 60625-2008

Phone 773-561-0870 · Fax 773-561-4185

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