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General NPI Number Information
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NPI Number | 1619190493
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Entity Type | Individual
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Provider Name | OLESSIA XENIA BUTENKO OD
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Gender | Female
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 3018 EAST AVE INSIDE WALMART VISION CENTER
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City | CENTRAL SQUARE
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State | NY
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Zip | 13036-2713
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Country | US
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Telephone | 315-668-0422
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Fax | 315-668-0424
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Provider Business Mailing Address
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Address Line | 131 TEMPLE ST
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City | OWEGO
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State | NY
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Zip | 13827-1420
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Country | US
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Telephone | 607-760-9275
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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 | TUV006228
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License Number State | NY
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