Provider Demographics
NPI:1346680576
Name:KNOX, KOLBY (OD)
Entity Type:Individual
Prefix:
First Name:KOLBY
Middle Name:
Last Name:KNOX
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2240
Mailing Address - Country:US
Mailing Address - Phone:740-454-8581
Mailing Address - Fax:740-454-8810
Practice Address - Street 1:2008 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2240
Practice Address - Country:US
Practice Address - Phone:740-454-8581
Practice Address - Fax:740-454-8810
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6208152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0088357Medicaid
OHH229610Medicare PIN