Provider Demographics
NPI:1447251590
Name:BUTKA, WILLIAM A (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:BUTKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOPKINS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4641
Mailing Address - Country:US
Mailing Address - Phone:716-631-8888
Mailing Address - Fax:716-631-3803
Practice Address - Street 1:4250 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1414
Practice Address - Country:US
Practice Address - Phone:716-648-5329
Practice Address - Fax:716-648-3185
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006068152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC1202OtherMEDICARE RAILROAD
NY02128614Medicaid
CC1202OtherMEDICARE RAILROAD
NY02128614Medicaid