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General NPI Number Information
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NPI Number | 1649586371
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Entity Type | Organization
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Legal Business Name | LORI A. BUTLER, O.D., LLC
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 3140 BRADFORD WOOD CT
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City | OAKTON
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State | VA
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Zip | 22124
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Country | US
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Telephone | 713-391-4655
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Fax | 703-281-0304
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Provider Business Mailing Address
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Address Line | 3140 BRADFORD WOOD CT
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City | OAKTON
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State | VA
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Zip | 22124-2738
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Country | US
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Telephone | 571-239-1465
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Fax | 703-281-0304
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | LORI A. BUTLER
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Credential | OD
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Telephone | 571-239-1465
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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 | 0618000335
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License Number State | VA
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