Provider Demographics
NPI:1174030225
Name:ALLEN BUTLER OD PA
Entity Type:Organization
Organization Name:ALLEN BUTLER OD PA
Other - Org Name:FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JENKINS
Authorized Official - Last Name:COTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-389-7579
Mailing Address - Street 1:200 DOCTORS DR STE K
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6308
Mailing Address - Country:US
Mailing Address - Phone:910-353-0541
Mailing Address - Fax:910-353-5353
Practice Address - Street 1:200 DOCTORS DR STE K
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6308
Practice Address - Country:US
Practice Address - Phone:910-353-0541
Practice Address - Fax:910-353-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty