Provider Demographics
NPI:1760434294
Name:BUTLER, PATRICIA A (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 S. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WILKES-BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1723
Mailing Address - Country:US
Mailing Address - Phone:570-822-8727
Mailing Address - Fax:570-822-8743
Practice Address - Street 1:34 S MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1723
Practice Address - Country:US
Practice Address - Phone:570-822-8727
Practice Address - Fax:570-822-8743
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG1584152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7033765Medicaid
PAU46831Medicare UPIN
PABU064491Medicare ID - Type Unspecified