Provider Demographics
NPI:1265563548
Name:BURTON G. PINCHUK, O.D.,P.C.
Entity type:Organization
Organization Name:BURTON G. PINCHUK, O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:PINCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-759-5100
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:60440-1872
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006482152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL240690Medicare ID - Type Unspecified
ILT 35537Medicare UPIN
ILIL3213Medicare PIN