Provider Demographics
NPI:1770884488
Name:INDUSTRIAL OPTICAL SERVICE, INC
Entity type:Organization
Organization Name:INDUSTRIAL OPTICAL SERVICE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPOMETRIST
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 1:115 S LASALLE ST
Mailing Address - Street 2:27TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3801
Mailing Address - Country:US
Mailing Address - Phone:312-673-7192
Mailing Address - Fax:
Practice Address - Street 1:3760 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4105
Practice Address - Country:US
Practice Address - Phone:773-975-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1636706OtherBCBS
7235044OtherAETNA
210209Medicare PIN