Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 0618001415 | VA |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1944 | NC |
NPI | 1114928934 |
---|---|
Provider Name | Dr. G. Nathan Butterworth |
First Address | Martinsville, VA 24112-8388 |
Second Address | Martinsville, VA 24112-8388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 10/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010103282 | (05) | VA |
V00680 | (02) | VA |