Provider Demographics
NPI:1366798100
Name:BUTORAC, GEOFF SCOTT (OD)
Entity type:Individual
Prefix:DR
First Name:GEOFF
Middle Name:SCOTT
Last Name:BUTORAC
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:2245 E MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2786
Practice Address - Country:US
Practice Address - Phone:317-837-7800
Practice Address - Fax:317-837-7810
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003757A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400074738Medicare PIN
ININ1942006Medicare PIN