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NPI Code Detail

MEDICARE: KIM JOHNSON BUTLER O.D.

MEDICARE: KIM JOHNSON BUTLER 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
1152W00000XOptometristOPT6405TPACA
2152WC0802XCorneal and Contact Management OptometristOPT6405TPACA
3152WX0102XOccupational Vision OptometristOPT6405TPACA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467444844
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM JOHNSON BUTLER O.D.
Provider Business Mailing Address
First Line : 1273 BROADWAY
Second Line :
City : EL CAJON
State : CA
Zip : 92021-4902
Country : US
Telephone Number : 619-579-2345
Fax Number : 619-579-0876
Provider Business Practice Location Address
First Line : 1273 BROADWAY
Second Line :
City : EL CAJON
State : CA
Zip : 92021-4902
Country : US
Telephone Number : 619-579-2345
Fax Number : 619-579-0876
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 07/24/2009

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