Basic Information
| Provider Information | |||||||||
| NPI: | 1447251590 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUTKA | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HOPKINS RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142214641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166318888 | ||||||||
| FaxNumber: | 7166313803 | ||||||||
| Practice Location | |||||||||
| Address1: | 4250 SOUTHWESTERN BLVD | ||||||||
| Address2: | |||||||||
| City: | HAMBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140751414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166485329 | ||||||||
| FaxNumber: | 7166483185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 006068 | NY | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | CC1202 | 01 | MEDICARE RAILROAD | OTHER | 02128614 | 05 | NY | MEDICAID |