Provider Demographics
NPI:1851362453
Name:BUTTON, MARY ANN (OD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:BUTTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2640 BIEHN ST
Mailing Address - Street 2:STE 3
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1181
Mailing Address - Country:US
Mailing Address - Phone:541-884-3148
Mailing Address - Fax:541-884-3373
Practice Address - Street 1:628 N 1ST ST
Practice Address - Street 2:STE C
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630-1506
Practice Address - Country:US
Practice Address - Phone:541-947-3357
Practice Address - Fax:541-947-3368
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2015-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OR2599ATI152W00000X
CAOPT11282TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U62890Medicare UPIN
131367Medicare PIN