Healthcare Provider Details

I. General information

NPI: 1063675528
Provider Name (Legal Business Name): SHARON M ROVENSTINE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2008
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 W 75TH ST STE 119
NAPERVILLE IL
60540-9446
US

IV. Provider business mailing address

4050 HEALTHWAY DR SUITE 100
AURORA IL
60504-8183
US

V. Phone/Fax

Practice location:
  • Phone: 630-225-7020
  • Fax: 630-995-9772
Mailing address:
  • Phone: 630-820-1303
  • Fax: 630-820-1398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number046.010067
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number046.010067
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.010067
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: