Provider Demographics
NPI:1265476725
Name:ROSANOVA EYECARE LLC
Entity Type:Organization
Organization Name:ROSANOVA EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ROSANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-882-8680
Mailing Address - Street 1:5872 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5425
Mailing Address - Country:US
Mailing Address - Phone:773-594-0000
Mailing Address - Fax:773-594-0017
Practice Address - Street 1:1555 N BARRINGTON RD
Practice Address - Street 2:DOB 1, SUITE 330
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-4033
Practice Address - Country:US
Practice Address - Phone:847-882-8680
Practice Address - Fax:877-776-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067273207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634901OtherBLUE CROSS BLUE SHIELD
IL01634901OtherBLUE CROSS BLUE SHIELD
IL210896Medicare ID - Type Unspecified