Provider Demographics
NPI:1003205394
Name:INDUSTRIAL OPTICAL SERVICE INC.
Entity Type:Organization
Organization Name:INDUSTRIAL OPTICAL SERVICE INC.
Other - Org Name:SPEX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROITSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-945-7192
Mailing Address - Street 1:724 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1820
Mailing Address - Country:US
Mailing Address - Phone:847-295-2020
Mailing Address - Fax:847-295-2021
Practice Address - Street 1:724 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1820
Practice Address - Country:US
Practice Address - Phone:847-295-2020
Practice Address - Fax:847-295-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1636706OtherBCBS IL
IL8825444OtherMULTIPLAN
IL8825444OtherMULTIPLAN
IL211019Medicare PIN