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Individual

DR. TASSO S BUTLER JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
413 GREENBRIER VALLY MALL DR, SUITE 2, LEWISBURG, WV 24901-1794
(304) 645-2799
(304) 647-3962
Mailing address
US RT 219, GREENBRIER VALLEY MALL, LEWISBURG, WV 24901
(304) 645-2799
(304) 647-3962

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
0601000803
VA
152W00000X
Optometrist
Primary
658OD
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
001717454
BC BS MT STATE
WV
05
009206698
VA
05
0150878000
WV
01
208525
BLUE CROSS/BLUE SHIELD
VA
01
410002504
RR MEDICARE
WV
01
410038164
RAILROAD MEDICARE
VA
Enumeration date
05/16/2006
Last updated
04/28/2011
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