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NPI Code Detail

MEDICARE: INDUSTRIAL OPTICAL SERVICE, INC

MEDICARE: INDUSTRIAL OPTICAL SERVICE, 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
1152W00000XOptometrist046009268IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101636706OTHERILBCBS
27235044OTHERILAETNA
38825444OTHERILMULTIPLAN

General Provider Information

NPI Number : 1265832455
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDUSTRIAL OPTICAL SERVICE, INC
Provider Business Mailing Address
First Line : 890 WILLIAM HILTON PKWY
Second Line : SUITE 93
City : HILTON HEAD
State : SC
Zip : 29928-3418
Country : US
Telephone Number : 843-681-2020
Fax Number :
Provider Business Practice Location Address
First Line : 890 WILLIAM HILTON PKWY
Second Line : SUITE 93
City : HILTON HEAD
State : SC
Zip : 29928-3418
Country : US
Telephone Number : 843-681-2020
Fax Number :
Authorized Official
Title or Position : MANAGING DOCTOR
Name : CARRIE ROITSTEIN
Credential : O.D.
Telephone Number : 312-945-7192
Provider Enumeration Date : 08/26/2014
Last Update Date : 08/26/2014

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Directions to “INDUSTRIAL OPTICAL SERVICE, INC ” Practice Location

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