Provider Demographics
NPI:1710076245
Name:BUTZ, RICHARD FRANK (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FRANK
Last Name:BUTZ
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 1:1112 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-7682152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL91895Medicare UPIN
IL991500Medicare ID - Type Unspecified