Provider Demographics
NPI:1710010608
Name:DUPAGE OPTICAL, INC.
Entity Type:Organization
Organization Name:DUPAGE OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUTZON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-279-8866
Mailing Address - Street 1:207 S ADDISON RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3809
Mailing Address - Country:US
Mailing Address - Phone:630-279-8866
Mailing Address - Fax:630-279-2609
Practice Address - Street 1:207 S ADDISON RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3809
Practice Address - Country:US
Practice Address - Phone:630-279-8866
Practice Address - Fax:630-279-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X, 152W00000X, 152WC0802X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMB0237568OtherDEA
ILMB0237568OtherDEA
ILU03058Medicare UPIN
ILU57929Medicare UPIN
ILL90052Medicare ID - Type UnspecifiedMEDICARE MEDICAID
IL0891790001Medicare NSC