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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
1152W00000XOptometristIL

General Provider Information

NPI Number : 1851441968
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDUSTRIAL OPTICAL SERVICE, INC.
Provider Business Mailing Address
First Line : 4418 W DIVERSEY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-1924
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2316 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-7760
Country : US
Telephone Number : 773-404-0777
Fax Number :
Authorized Official
Title or Position : OPTOMETRIST
Name : CARRIE B ROITSTEIN
Credential : O.D.
Telephone Number : 773-404-0777
Provider Enumeration Date : 01/11/2007
Last Update Date : 08/22/2020

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Directions to “INDUSTRIAL OPTICAL SERVICE, INC. ” Practice Location

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