Provider Demographics
NPI:1336284736
Name:BUSEY, TIMOTHY DELBERT (OD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DELBERT
Last Name:BUSEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549
Mailing Address - Country:US
Mailing Address - Phone:217-864-3221
Mailing Address - Fax:217-864-3345
Practice Address - Street 1:1505 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MT ZION
Practice Address - State:IL
Practice Address - Zip Code:62549
Practice Address - Country:US
Practice Address - Phone:217-864-3221
Practice Address - Fax:217-864-3345
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT95857Medicare UPIN