=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982676300
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA L BUTTERWORTH O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2345 MULBERRY ST UNIT 5
-----------------------------------------------------
City | CORALVILLE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52241-3385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-358-9770
-----------------------------------------------------
Fax | 319-354-4751
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2345 MULBERRY ST UNIT 5
-----------------------------------------------------
City | CORALVILLE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52241-3385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-358-9770
-----------------------------------------------------
Fax | 319-354-4751
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 02174
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------