Healthcare Provider Details

I. General information

NPI: 1710010608
Provider Name (Legal Business Name): DUPAGE OPTICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S ADDISON RD
ADDISON IL
60101-3809
US

IV. Provider business mailing address

207 S ADDISON RD
ADDISON IL
60101-3809
US

V. Phone/Fax

Practice location:
  • Phone: 630-279-8866
  • Fax: 630-279-2609
Mailing address:
  • Phone: 630-279-8866
  • Fax: 630-279-2609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. STEVEN P. BUTZON
Title or Position: OWNER
Credential: O.D.
Phone: 630-279-8866