Organization
NORTHERN ILLINOIS OPTICAL CO., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERI M DE ROSSO (OWNER)
(815) 963-3454
Entity
Organization
Contact information
Practice address
121 N MADISON ST, ROCKFORD, IL 61107-3949
(815) 963-3454
(815) 963-4384
Mailing address
121 N MADISON ST, ROCKFORD, IL 61107-3949
(815) 963-3454
(815) 963-4384
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10115103
BCBS
IL
Enumeration date
10/24/2006
Last updated
11/07/2024
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