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General NPI Number Information
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NPI Number | 1942346150
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Entity Type | Individual
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Provider Name | KENNITH BUTLER
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 123 N MUSTANG RD
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City | MUSTANG
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State | OK
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Zip | 73064-3912
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Country | US
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Telephone | 405-376-0222
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Fax | 405-376-0233
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Provider Business Mailing Address
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Address Line | 123 N MUSTANG RD
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City | MUSTANG
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State | OK
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Zip | 73064-3912
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Country | US
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Telephone | 405-376-0222
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Fax | 405-376-0233
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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