Provider Demographics
NPI:1376726000
Name:RICHARD F BUTZ
Entity Type:Organization
Organization Name:RICHARD F BUTZ
Other - Org Name:PROFESSIONAL EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:BUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-355-6878
Mailing Address - Street 1:1112 S WASHINGTON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7959
Mailing Address - Country:US
Mailing Address - Phone:630-355-6878
Mailing Address - Fax:630-355-0043
Practice Address - Street 1:1112 S WASHINGTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7959
Practice Address - Country:US
Practice Address - Phone:630-355-6878
Practice Address - Fax:630-355-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-7682302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36368668FMedicaid
IL36368668FMedicaid
IL991500Medicare PIN