Provider Demographics
NPI:1598107047
Name:ROSE OCAMPO INC
Entity Type:Organization
Organization Name:ROSE OCAMPO INC
Other - Org Name:MY BEAUTIFUL EYES OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:OCAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:7089279727
Authorized Official - Phone:708-927-9727
Mailing Address - Street 1:126 S 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-1206
Mailing Address - Country:US
Mailing Address - Phone:708-927-9727
Mailing Address - Fax:866-599-3488
Practice Address - Street 1:9825 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2747
Practice Address - Country:US
Practice Address - Phone:708-927-9727
Practice Address - Fax:866-599-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid