Provider Demographics
NPI:1265832455
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:OD
Authorized Official - Phone:312-945-7192
Mailing Address - Street 1:890 WILLIAM HILTON PKWY
Mailing Address - Street 2:SUITE 93
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29928-3418
Mailing Address - Country:US
Mailing Address - Phone:843-681-2020
Mailing Address - Fax:
Practice Address - Street 1:890 WILLIAM HILTON PKWY
Practice Address - Street 2:SUITE 93
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29928-3418
Practice Address - Country:US
Practice Address - Phone:843-681-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009268152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636706OtherBCBS
IL7235044OtherAETNA
IL8825444OtherMULTIPLAN
IL7235044OtherAETNA