Provider Demographics
NPI:1114928934
Name:BUTTERWORTH, G. NATHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:G.
Middle Name:NATHAN
Last Name:BUTTERWORTH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-8388
Mailing Address - Country:US
Mailing Address - Phone:276-647-3937
Mailing Address - Fax:276-647-3990
Practice Address - Street 1:1975 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-8388
Practice Address - Country:US
Practice Address - Phone:276-647-3937
Practice Address - Fax:276-647-3990
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2019-06-10
Deactivation Date:2019-06-05
Deactivation Code:
Reactivation Date:2019-06-10
Provider Licenses
StateLicense IDTaxonomies
VA0618001415152W00000X
NC1944152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010103282Medicaid
VAV00680Medicare UPIN
VA010103282Medicaid