Healthcare Provider Details

I. General information

NPI: 1235343641
Provider Name (Legal Business Name): ROSIN OPTICAL CO., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6233 CERMAK RD
BERWYN IL
60402-2317
US

IV. Provider business mailing address

6233 CERMAK RD
BERWYN IL
60402-2317
US

V. Phone/Fax

Practice location:
  • Phone: 630-546-8319
  • Fax: 708-749-2069
Mailing address:
  • Phone: 630-546-8319
  • Fax: 708-749-2069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS A. CHIARAMONTI JR.
Title or Position: DIRECTOR OF PROFESSIONAL SERVICES
Credential: O.D.
Phone: 630-546-8319