Individual
OLESSIA XENIA BUTENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
3018 EAST AVE, INSIDE WALMART VISION CENTER, CENTRAL SQUARE, NY 13036-2713
(315) 668-0422
(315) 668-0424
Mailing address
131 TEMPLE ST, OWEGO, NY 13827-1420
(607) 760-9275
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV006228
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000125424
BCBS
NY
01
—
27761
SUPERIOR
NY
01
—
366116
MVP
NY
Enumeration date
04/10/2007
Last updated
02/15/2012
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