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General NPI Number Information
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NPI Number | 1548589229
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Entity Type | Organization
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Legal Business Name | INDUSTRIAL OPTICAL SERVICE, INC.
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 4740 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2247
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Country | US
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Telephone | 773-275-2900
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Fax | 773-275-1307
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Provider Business Mailing Address
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Address Line | 4740 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2247
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Country | US
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Telephone | 773-275-2900
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Fax | 773-275-1307
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Authorized Official
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Title or Position | MANAGING DOCTOR
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Name | CARRIE ROITSTEIN
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Credential | O.D.
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Telephone | 312-673-7192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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