Kim Johnson Butler, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT6405TPA Issued in CA

Practice address

1273 Broadway
El Cajon, CA 92021-4902

Phone

(619) 579-2345

Fax

(619) 579-0876

NPI assigned

Aug 22, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248393600000",
    "number": "1467444844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1273 BROADWAY",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920214902",
            "telephone_number": "619-579-2345",
            "fax_number": "619-579-0876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1273 BROADWAY",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920214902",
            "telephone_number": "619-579-2345",
            "fax_number": "619-579-0876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "KIM",
        "middle_name": "JOHNSON",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2009-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT6405TPA",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "OPT6405TPA",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "CA",
            "license": "OPT6405TPA",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0064050",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0064051",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ana Marie Burr
• Swapna Busa, M.D
• Ojore Lateef Bushfan, MFTI
• Issac Manuel Bustamante
• Erycha Butler
• Sarah Ann Butler
• Esther Butrus
• Buxton Behavioral Collective LLC
• Andrew Lancaster Byrne, IMFT
• Melina Caan, MA

• Optometrist in El Cajon, CA
• Providers in El Cajon, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.