Provider Demographics
NPI:1013395516
Name:BUTLER, ANGELA KRISTINE (ABOC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:KRISTINE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 PLUMAS ST
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4434
Mailing Address - Country:US
Mailing Address - Phone:530-673-2828
Mailing Address - Fax:530-673-6888
Practice Address - Street 1:644 PLUMAS ST
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4434
Practice Address - Country:US
Practice Address - Phone:530-673-2828
Practice Address - Fax:530-673-6888
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL5167156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician