Healthcare Provider Details

I. General information

NPI: 1689130320
Provider Name (Legal Business Name): ROSIN OPTICAL CO. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13231 W 143RD ST
HOMER GLEN IL
60491-6638
US

IV. Provider business mailing address

6233 CERMAK RD
BERWYN IL
60402-2317
US

V. Phone/Fax

Practice location:
  • Phone: 708-301-2020
  • Fax: 708-301-0884
Mailing address:
  • Phone: 630-546-8319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

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