Healthcare Provider Details

I. General information

NPI: 1376692574
Provider Name (Legal Business Name): CHRISTOPHER ROKOSZ O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 GOLF MILL CTR
NILES IL
60714-1217
US

IV. Provider business mailing address

402 E PINE LAKE CIR
VERNON HILLS IL
60061-1202
US

V. Phone/Fax

Practice location:
  • Phone: 847-803-1770
  • Fax:
Mailing address:
  • Phone: 847-968-2575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-009039
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: