Healthcare Provider Details

I. General information

NPI: 1477767796
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: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N MICHIGAN AVE SUITE 210
CHICAGO IL
60611-2826
US

IV. Provider business mailing address

645 N MICHIGAN AVE SUITE 210
CHICAGO IL
60611-2826
US

V. Phone/Fax

Practice location:
  • Phone: 312-787-2020
  • Fax: 312-787-2374
Mailing address:
  • Phone: 312-787-2020
  • Fax: 312-787-2374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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