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
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8825444	OTHER	IL	MULTIPLAN
2	01636706	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1518239847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDUSTRIAL OPTICAL SERVICE, INC.

Provider Business Mailing Address
First Line	:	1407 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2015
Country	:	US
Telephone Number	:	773-276-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1407 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2015
Country	:	US
Telephone Number	:	773-276-2020
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DOCTOR
Name	:	CARRIE ROITSTEIN
Credential	:	O.D.
Telephone Number	:	312-673-7192

Provider Enumeration Date	:	02/01/2012
Last Update Date	:	02/01/2012

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