1235343641 NPI number — ROSIN OPTICAL CO., INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235343641 NPI number — ROSIN OPTICAL CO., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSIN OPTICAL CO., INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235343641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6233 CERMAK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERWYN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60402-2317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-546-8319
Provider Business Mailing Address Fax Number:
708-749-2069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6233 CERMAK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERWYN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60402-2317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-546-8319
Provider Business Practice Location Address Fax Number:
708-749-2069
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHIARAMONTI
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
DIRECTOR OF PROFESSIONAL SERVICES
Authorized Official Telephone Number:
630-546-8319

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CA2163 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com