MEDICARE: DR. ROBERT D BUTTERWICK O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1472	GA

General Provider Information

NPI Number	:	1174630024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT D BUTTERWICK O.D.

Provider Business Mailing Address
First Line	:	2625 PIEDMONT RD NE
Second Line	:	SUITE 36G
City	:	ATLANTA
State	:	GA
Zip	:	30324-3086
Country	:	US
Telephone Number	:	404-233-3513
Fax Number	:	404-814-0184

Provider Business Practice Location Address
First Line	:	2625 PIEDMONT RD NE
Second Line	:	SUITE 36G
City	:	ATLANTA
State	:	GA
Zip	:	30324-3086
Country	:	US
Telephone Number	:	404-233-3513
Fax Number	:	404-814-0184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	03/15/2018

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