1154337947 NPI number — MICHELLE BUTTLAR, OD, PC

Table of content: (NPI 1154337947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154337947 NPI number — MICHELLE BUTTLAR, OD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHELLE BUTTLAR, OD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SCHERTZ VISION SOURCE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154337947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17323 IH 35 N STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHERTZ
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78154-1278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-651-5800
Provider Business Mailing Address Fax Number:
210-651-9733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17323 IH 35 N
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SCHERTZ
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78154-1277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-651-5800
Provider Business Practice Location Address Fax Number:
210-651-9733
Provider Enumeration Date:
07/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUTTLAR
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
210-651-5800

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3140TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3140TG . This is a "TEXAS OPTOMETRY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7207TG . This is a "TEXAS OPTOMETRY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".