MEDICARE: ROSIN OPTICAL CO. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046008520	IL

General Provider Information

NPI Number	:	1194206078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSIN OPTICAL CO. INC.

Provider Business Mailing Address
First Line	:	1706 E ROOSEVELT RD
Second Line	:
City	:	WHEATON
State	:	IL
Zip	:	60187-6838
Country	:	US
Telephone Number	:	630-546-8319
Fax Number	:

Provider Business Practice Location Address
First Line	:	3934 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4639
Country	:	US
Telephone Number	:	773-687-8383
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. NICHOLAS ANTHONY CHIARAMONTI JR.
Credential	:	O.D.
Telephone Number	:	630-546-8319

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	08/28/2018

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