Provider Demographics
NPI:1376523639
Name:BUTNER, JAMES K (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:BUTNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 926
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-0926
Mailing Address - Country:US
Mailing Address - Phone:918-256-5543
Mailing Address - Fax:918-256-6118
Practice Address - Street 1:529 N WILSON ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-2428
Practice Address - Country:US
Practice Address - Phone:918-256-5543
Practice Address - Fax:918-256-6118
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK972152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100762650AMedicaid
OK100762650AMedicaid
OKT40379Medicare UPIN
OK237292001Medicare PIN