Healthcare Provider Details

I. General information

NPI: 1922256239
Provider Name (Legal Business Name): DR. SHARON ROVENSTINE, OPTOMETRIST, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 HEALTHWAY DR SUITE 100
AURORA IL
60504-8183
US

IV. Provider business mailing address

4050 HEALTHWAY DR SUITE 100
AURORA IL
60504-8183
US

V. Phone/Fax

Practice location:
  • Phone: 630-820-1303
  • Fax: 630-820-1398
Mailing address:
  • Phone: 630-820-1303
  • Fax: 630-820-1398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number046-010067
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number046-010067
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number046-010067
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-010067
License Number StateIL

VIII. Authorized Official

Name: DR. SHARON M ROVENSTINE
Title or Position: OPTOMETRIST/OWNER
Credential: O.D.
Phone: 630-820-1303