Healthcare Provider Details

I. General information

NPI: 1003325135
Provider Name (Legal Business Name): ROSIN OPTICAL CO. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 DANADA SQ W
WHEATON IL
60189-2041
US

IV. Provider business mailing address

6233 CERMAK RD
BERWYN IL
60402-2317
US

V. Phone/Fax

Practice location:
  • Phone: 630-752-0595
  • Fax: 630-752-0145
Mailing address:
  • Phone: 708-749-2020
  • Fax: 708-749-2069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-008520
License Number StateIL

VIII. Authorized Official

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