Butler, Kim Johnson
Butler, Kim Johnson is an sole proprietor health care provider with primary practice located at 1273 Broadway , El Cajon CA 92021-4902. He recently has 3 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Occupational Vision. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Butler, Kim Johnson can be contacted via phone (619) 579-2345.Contact Information
Primary practice address
1273 Broadway
El Cajon CA 92021-4902
Phone: (619) 579-2345
Fax: (619) 579-0876
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OPT6405TPA | California |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | OPT6405TPA | California |
| Eye and Vision Services Providers / Occupational Vision | 152WX0102X | OPT6405TPA | California |
Profile Details
| NPI number | 1467444844 |
|---|---|
| LBN Legal business name | Butler, Kim Johnson |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 22nd, 2005 |
| Last updated | Jul 24th, 2009 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1467444844 | NPPES |
| California | MEDICAID | SD0064050 | |
| California | MEDICAID | SD0064051 |
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