Healthcare Provider Details

I. General information

NPI: 1447873260
Provider Name (Legal Business Name): PRAKSHA BUTALA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 ROUTE 10 E
SUCCASUNNA NJ
07876-1431
US

IV. Provider business mailing address

7 SER DEL DR
PARSIPPANY NJ
07054-2235
US

V. Phone/Fax

Practice location:
  • Phone: 973-927-7717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005948
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA3148
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00726600
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OM00194000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: