=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598107047
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSE OCAMPO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2013
-----------------------------------------------------
Last Update Date | 06/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9825 W ROOSEVELT RD
-----------------------------------------------------
City | WESTCHESTER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60154-2747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-927-9727
-----------------------------------------------------
Fax | 866-599-3488
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 S 15TH AVE
-----------------------------------------------------
City | MAYWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60153-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-927-9727
-----------------------------------------------------
Fax | 866-599-3488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. ROSE OCAMPO
-----------------------------------------------------
Credential | 7089279727
-----------------------------------------------------
Telephone | 708-927-9727
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------