Basic Information
| Provider Information | |||||||||
| NPI: | 1396950846 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROSIN OPTICAL CO., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1987 W. GALENA BLVD | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308926610 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1987 W. GALENA BLVD | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308926610 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 05/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | CHIARAMONTI | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PROFESSIONAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 6305468319 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ROSIN OPTICAL CO., INC. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | O.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | N | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | CE1654 | 01 | IL | MEDICARE RR | OTHER |