Healthcare Provider Details

I. General information

NPI: 1730321720
Provider Name (Legal Business Name): NORTHWESTERN-ROSIN EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 08/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST 15-120
CHICAGO IL
60611-5975
US

IV. Provider business mailing address

6233 CERMAK RD
BERWYN IL
60402-2317
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-4100
  • Fax:
Mailing address:
  • Phone: 708-749-2020
  • Fax: 708-749-2069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: 708-749-2020