Healthcare Provider Details

I. General information

NPI: 1831540897
Provider Name (Legal Business Name): ROSIN OPTICAL CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 N RANDALL RD SUITE 102
ELGIN IL
60123-2306
US

IV. Provider business mailing address

6233 CERMAK RD
BERWYN IL
60402-2317
US

V. Phone/Fax

Practice location:
  • Phone: 847-841-8866
  • Fax: 847-841-8986
Mailing address:
  • Phone: 708-749-2020
  • Fax: 708-749-2069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036052088
License Number StateIL

VIII. Authorized Official

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