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General NPI Number Information
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NPI Number | 1114425774
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Entity Type | Organization
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Legal Business Name | BUTLER OPTICAL, LLC
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 01/30/2018
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Provider Practice Location Address
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Address Line | 1718 SUMNER AVE
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City | ABERDEEN
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State | WA
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Zip | 98520-4616
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Country | US
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Telephone | 360-681-3478
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Fax | 360-612-3520
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Provider Business Mailing Address
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Address Line | 1718 SUMNER AVE
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City | ABERDEEN
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State | WA
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Zip | 98520-4616
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Country | US
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Telephone | 360-681-3478
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Fax | 360-612-3520
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSH BUTLER
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Credential | DO
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Telephone | 360-612-3478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO60108194
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License Number State | WA
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