Physician Compare National (NPI:1619190493)

HEALTHCARE PROVIDER: OLESSIA XENIA BUTENKO OD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1619190493
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9133218035
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20071129000613
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BUTENKO
	Individual professional last name
Provider First Name	OLESSIA
	Individual professional first name
Provider Middle Name	X
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NEW ENGLAND COLLEGE OF OPTOMETRY
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	20823 STATE ROUTE 3
	Group Practice or individual's line 1 address
City	WATERTOWN
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	136015577
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3157881570
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y