Basic Information
| Provider Information | |||||||||
| NPI: | 1578798989 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROSIN OPTICAL CO., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6233 CERMAK RD | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604022317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087492020 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 W RANDOLPH ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606013218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122634909 | ||||||||
| FaxNumber: | 3122634932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2009 | ||||||||
| LastUpdateDate: | 05/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | CHIARAMONTI | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PROFESSIONAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 6305468319 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
ID Information
| ID | Type | State | Issuer | Description | CA2163 | 01 | MEDICARE RR | OTHER |