Provider Demographics
NPI:1134180060
Name:ROITSTEIN, CARRIE (OD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:
Last Name:ROITSTEIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4102
Mailing Address - Country:US
Mailing Address - Phone:630-325-2020
Mailing Address - Fax:
Practice Address - Street 1:12 E FIRST ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4102
Practice Address - Country:US
Practice Address - Phone:630-325-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2020-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009268152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211019OtherMEDICARE GROUP
IL210209OtherMEDICARE GROUP
IL1636706OtherBCBS
IL7235044OtherAETNA
IL046009268Medicaid
ILK15491Medicare PIN
IL7235044OtherAETNA
IL615240Medicare ID - Type Unspecified
IL0757500001Medicare NSC
IL211019OtherMEDICARE GROUP
IL0757500003Medicare NSC