Provider Demographics
NPI:1730321720
Name:NORTHWESTERN-ROSIN EYECARE LLC
Entity Type:Organization
Organization Name:NORTHWESTERN-ROSIN EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROFESSIONAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHIARAMONTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:708-749-2020
Mailing Address - Street 1:6233 CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2317
Mailing Address - Country:US
Mailing Address - Phone:708-749-2020
Mailing Address - Fax:708-749-2069
Practice Address - Street 1:675 N SAINT CLAIR ST
Practice Address - Street 2:15-120
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:312-695-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6327490001Medicare NSC