Provider Demographics
NPI:1619230638
Name:BUTTS, DAWN LYNETTE (OD)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:LYNETTE
Last Name:BUTTS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:LYNETTE
Other - Last Name:TANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4208 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704
Mailing Address - Country:US
Mailing Address - Phone:608-249-0667
Mailing Address - Fax:608-249-2093
Practice Address - Street 1:4208 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704
Practice Address - Country:US
Practice Address - Phone:608-249-0667
Practice Address - Fax:608-249-2093
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3265-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist