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General NPI Number Information
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NPI Number | 1851362453
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Entity Type | Individual
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Provider Name | MARY ANN BUTTON OD
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Gender | Female
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 628 N 1ST ST STE C
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City | LAKEVIEW
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State | OR
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Zip | 97630-1506
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Country | US
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Telephone | 541-947-3357
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Fax | 541-947-3368
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Provider Business Mailing Address
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Address Line | 2640 BIEHN ST STE 3
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-1181
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Country | US
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Telephone | 541-884-3148
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Fax | 541-884-3373
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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 | 2599ATI
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License Number State | OR
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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 | OPT11282TPA
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License Number State | CA
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