Provider Demographics
NPI:1104206622
Name:BUTZ, STACEY (OD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BUTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 NEW BYHALIA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3776
Mailing Address - Country:US
Mailing Address - Phone:901-854-6798
Mailing Address - Fax:
Practice Address - Street 1:231 NEW BYHALIA RD STE 100
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3776
Practice Address - Country:US
Practice Address - Phone:901-854-6798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3238152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist