Healthcare Provider Details

I. General information

NPI: 1669836011
Provider Name (Legal Business Name): ROSIN OPTICAL CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 E ROOSEVELT RD
WHEATON IL
60187-6838
US

IV. Provider business mailing address

1706 E ROOSEVELT RD
WHEATON IL
60187-6838
US

V. Phone/Fax

Practice location:
  • Phone: 630-653-8885
  • Fax: 630-871-6639
Mailing address:
  • Phone: 630-653-8885
  • Fax: 630-871-6639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS ANTHONY CHIARAMONTI II
Title or Position: DIRECTOR
Credential: O.D.
Phone: 630-546-8319