Provider Demographics
NPI:1952976201
Name:BUTLER, JENNIFER ELISKA (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELISKA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 207261
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7261
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:
Practice Address - Street 1:775 W CORBETT AVE STE 1
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8563
Practice Address - Country:US
Practice Address - Phone:910-326-3050
Practice Address - Fax:610-326-7088
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2840152W00000X
VA0618003171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist