Provider Demographics
NPI:1033471818
Name:BUTORAC, ABBY LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:ABBY
Middle Name:LYNN
Last Name:BUTORAC
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17151 MERCANTILE BLVD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3942
Practice Address - Country:US
Practice Address - Phone:317-773-2300
Practice Address - Fax:317-773-7755
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003727A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201140730Medicaid
ININ1943006Medicare PIN
IN894060001Medicare Oscar/Certification
IN201140730Medicaid