Provider Demographics
NPI:1548589229
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:312-673-7192
Mailing Address - Street 1:4740 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2247
Mailing Address - Country:US
Mailing Address - Phone:773-275-2900
Mailing Address - Fax:773-275-1307
Practice Address - Street 1:4740 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2247
Practice Address - Country:US
Practice Address - Phone:773-275-2900
Practice Address - Fax:773-275-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0757500015OtherMEDICARE DME
IL1636706OtherBCBS
IL7235044OtherAETNA
IL210209Medicare PIN