Provider Demographics
NPI:1437131927
Name:KNAPP, WILLIAM RANDALL (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RANDALL
Last Name:KNAPP
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:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-0540
Mailing Address - Country:US
Mailing Address - Phone:419-294-2421
Mailing Address - Fax:419-294-2499
Practice Address - Street 1:212 E WYANDOT AVE
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-1432
Practice Address - Country:US
Practice Address - Phone:419-294-2421
Practice Address - Fax:419-294-2499
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4759/T1563152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2031661Medicaid
OH0816951Medicare PIN
OH2031661Medicaid