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General NPI Number Information
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NPI Number | 1245751759
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Entity Type | Individual
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Provider Name | CHARLTON BUTTS OD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2710 SW PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-2849
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Country | US
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Telephone | 772-460-8487
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Fax |
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Provider Business Mailing Address
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Address Line | 7571 GILMOUR CT
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City | LAKE WORTH
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State | FL
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Zip | 33467-7816
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Country | US
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Telephone | 561-310-9562
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Fax |
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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 | 5438
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License Number State | FL
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