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General NPI Number Information
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NPI Number | 1205888757
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Entity Type | Individual
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Provider Name | TASSO S BUTLER JR. OD
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 04/28/2011
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Provider Practice Location Address
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Address Line | 413 GREENBRIER VALLY MALL DR SUITE 2
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City | LEWISBURG
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State | WV
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Zip | 24901-1794
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Country | US
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Telephone | 304-645-2799
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Fax | 304-647-3962
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Provider Business Mailing Address
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Address Line | US RT 219 GREENBRIER VALLEY MALL
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City | LEWISBURG
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State | WV
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Zip | 24901
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Country | US
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Telephone | 304-645-2799
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Fax | 304-647-3962
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0601000803
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 658OD
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License Number State | WV
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