Provider Demographics
NPI:1134323082
Name:JEAN-LOUIS, BUTLER (O,D)
Entity Type:Individual
Prefix:DR
First Name:BUTLER
Middle Name:
Last Name:JEAN-LOUIS
Suffix:
Gender:M
Credentials:O,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2412
Mailing Address - Country:US
Mailing Address - Phone:973-748-4647
Mailing Address - Fax:
Practice Address - Street 1:321 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2412
Practice Address - Country:US
Practice Address - Phone:973-748-4647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA003923000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ595990OtherAETNA US HEALTHCARE
NJ521409Medicare ID - Type Unspecified