Basic Information
Provider Information
NPI: 1740847086
EntityType: 2
ReplacementNPI:  
OrganizationName: ROSIN EYECARE P.C.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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OtherCredential:  
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Mailing Information
Address1: 6233 CERMAK RD
Address2:  
City: BERWYN
State: IL
PostalCode: 604022317
CountryCode: US
TelephoneNumber: 7087492020
FaxNumber: 7087492069
Practice Location
Address1: 412 ELYSIAN FIELDS RD
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372114211
CountryCode: US
TelephoneNumber: 6158348495
FaxNumber: 6158331143
Other Information
ProviderEnumerationDate: 05/22/2019
LastUpdateDate: 05/22/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: CHIARAMONTI
AuthorizedOfficialFirstName: NICHOLAS
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: DIRECTOR
AuthorizedOfficialTelephone: 6305468319
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix: JR.
AuthorizedOfficialCredential: OD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X  Y193400000X SINGLE SPECIALTY GROUPEye and Vision Services ProvidersOptometrist 

No ID Information.


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