Provider Demographics
NPI:1952770604
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:312-945-7192
Mailing Address - Street 1:444 N WABASH AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3539
Mailing Address - Country:US
Mailing Address - Phone:312-945-7192
Mailing Address - Fax:
Practice Address - Street 1:2843 PFINGSTEN RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1153
Practice Address - Country:US
Practice Address - Phone:847-205-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDUSTRIAL OPTICAL SERVICE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636706OtherBCBS ILLINOIS
IL8825444OtherMULTIPLAN
IL7235044OtherAETNA
IL0757500001Medicare NSC
IL8825444OtherMULTIPLAN