Healthcare Provider Details

I. General information

NPI: 1336284736
Provider Name (Legal Business Name): TIMOTHY DELBERT BUSEY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W MAIN ST
MT ZION IL
62549
US

IV. Provider business mailing address

1410 E VILLAGE PKWY
MT ZION IL
62549-1253
US

V. Phone/Fax

Practice location:
  • Phone: 217-864-3221
  • Fax: 217-864-3345
Mailing address:
  • Phone: 217-615-2510
  • Fax: 217-402-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046008141
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: