Provider Demographics
NPI:1114425774
Name:BUTLER OPTICAL, LLC
Entity Type:Organization
Organization Name:BUTLER OPTICAL, LLC
Other - Org Name:BUTLER OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-612-3478
Mailing Address - Street 1:1718 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-4616
Mailing Address - Country:US
Mailing Address - Phone:360-681-3478
Mailing Address - Fax:360-612-3520
Practice Address - Street 1:1718 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-4616
Practice Address - Country:US
Practice Address - Phone:360-681-3478
Practice Address - Fax:360-612-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO60108194156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty