Provider Demographics
NPI:1245576768
Name:LARA MCKNIGHT, OD & ASSOC LTD
Entity Type:Organization
Organization Name:LARA MCKNIGHT, OD & ASSOC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-722-0271
Mailing Address - Street 1:16012 GREEN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-8138
Mailing Address - Country:US
Mailing Address - Phone:775-722-0271
Mailing Address - Fax:
Practice Address - Street 1:4530 S CARSON ST STE 12
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-6914
Practice Address - Country:US
Practice Address - Phone:775-267-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV481152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100501811Medicaid
NVU97941Medicare UPIN