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General NPI Number Information
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NPI Number | 1578655593
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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 | 09/28/2006
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 4418 W DIVERSEY AVE
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City | CHICAGO
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State | IL
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Zip | 60639-1924
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Country | US
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Telephone | 773-736-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 4418 W DIVERSEY AVE
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City | CHICAGO
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State | IL
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Zip | 60639-1924
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Country | US
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Telephone | 773-736-6800
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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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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