Provider Demographics
NPI:1730291311
Name:BUTLER, PAMELA B (OD)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:B
Last Name:BUTLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:BANISTER
Other - Last Name:KOEPLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2301 W PARK ROW
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013
Mailing Address - Country:US
Mailing Address - Phone:817-460-5333
Mailing Address - Fax:817-461-4026
Practice Address - Street 1:2301 W PARK ROW
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013
Practice Address - Country:US
Practice Address - Phone:817-460-5333
Practice Address - Fax:817-461-4026
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5229TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U52595Medicare UPIN