Healthcare Provider Details

I. General information

NPI: 1598107047
Provider Name (Legal Business Name): ROSE OCAMPO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9825 W ROOSEVELT RD
WESTCHESTER IL
60154-2747
US

IV. Provider business mailing address

126 S 15TH AVE
MAYWOOD IL
60153-1206
US

V. Phone/Fax

Practice location:
  • Phone: 708-927-9727
  • Fax: 866-599-3488
Mailing address:
  • Phone: 708-927-9727
  • Fax: 866-599-3488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSE OCAMPO
Title or Position: PRESIDENT
Credential: 7089279727
Phone: 708-927-9727