MEDICARE: MRS. PAMELA B BUTLER OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5229TG	TX

General Provider Information

NPI Number	:	1730291311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA B BUTLER OD

Provider Business Mailing Address
First Line	:	2301 W PARK ROW
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013
Country	:	US
Telephone Number	:	817-460-5333
Fax Number	:	817-461-4026

Provider Business Practice Location Address
First Line	:	2301 W PARK ROW
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013
Country	:	US
Telephone Number	:	817-460-5333
Fax Number	:	817-461-4026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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