Provider Demographics
NPI:1215940630
Name:DOCTOR BUTLER EYECARE, LLC
Entity type:Organization
Organization Name:DOCTOR BUTLER EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-852-1920
Mailing Address - Street 1:34 S MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1723
Mailing Address - Country:US
Mailing Address - Phone:570-822-9727
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:570-822-9727
Practice Address - Fax:570-822-8743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG1584152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABU081836Medicare ID - Type Unspecified
PA6012810001Medicare NSC
116608Medicare PIN
PAU46831Medicare UPIN