Healthcare Provider Details

I. General information

NPI: 1144434143
Provider Name (Legal Business Name): ROSIN OPTICAL CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8580 W DEMPSTER ST
NILES IL
60714-1402
US

IV. Provider business mailing address

8580 W DEMPSTER ST
NILES IL
60714-1402
US

V. Phone/Fax

Practice location:
  • Phone: 847-699-8580
  • Fax: 847-699-5053
Mailing address:
  • Phone: 847-699-8580
  • Fax: 847-699-5053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

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