Healthcare Provider Details

I. General information

NPI: 1881676062
Provider Name (Legal Business Name): LINDA JO BUTLER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 GLEN ST.
GLENS FALLS NY
12801
US

IV. Provider business mailing address

575 GLEN ST. P.O. BOX 2071
GLENS FALLS NY
12801
US

V. Phone/Fax

Practice location:
  • Phone: 518-792-0518
  • Fax: 518-792-4739
Mailing address:
  • Phone: 518-792-0518
  • Fax: 518-792-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00530200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27TO00064500
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV0073681
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: