Provider Demographics
NPI:1699818922
Name:BUTLER, MELISSA J (OD OPTOMETRIST)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:BUTLER
Suffix:
Gender:F
Credentials:OD OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 RIDDELL ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2025
Mailing Address - Country:US
Mailing Address - Phone:413-774-7016
Mailing Address - Fax:413-773-7596
Practice Address - Street 1:33 RIDDELL ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2025
Practice Address - Country:US
Practice Address - Phone:413-774-7016
Practice Address - Fax:413-773-7596
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3657152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW17011OtherBCBS
MA0369276Medicaid
U57526Medicare UPIN
BUW17011Medicare ID - Type Unspecified