Provider Demographics
NPI:1760431324
Name:PINCHUK, BURTON GENE (OD)
Entity Type:Individual
Prefix:DR
First Name:BURTON
Middle Name:GENE
Last Name:PINCHUK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:402 W BOUGHTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1800
Mailing Address - Country:US
Mailing Address - Phone:630-759-5100
Mailing Address - Fax:630-759-5101
Practice Address - Street 1:402 W BOUGHTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1872
Practice Address - Country:US
Practice Address - Phone:630-759-5100
Practice Address - Fax:630-759-5101
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.006482152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046006482Medicaid
IL240690Medicare UPIN
IL046006482Medicaid
IL0165050001Medicare NSC