Provider Demographics
NPI:1568432714
Name:BUTLER, LORI A (OD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9530A BURKE RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3132
Mailing Address - Country:US
Mailing Address - Phone:703-272-7880
Mailing Address - Fax:703-272-7955
Practice Address - Street 1:9530A BURKE RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3132
Practice Address - Country:US
Practice Address - Phone:703-272-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000335152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU71182Medicare UPIN
VA408685Medicare PIN