Provider Demographics
NPI:1457310500
Name:MCKNIGHT, DIANA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LYNN
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:LYNN
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8419 ELK GROVE-FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-9518
Mailing Address - Country:US
Mailing Address - Phone:916-681-1101
Mailing Address - Fax:916-682-8891
Practice Address - Street 1:8419 ELK GROVE-FLORIN RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-9518
Practice Address - Country:US
Practice Address - Phone:916-681-1101
Practice Address - Fax:916-682-8891
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1107T152W00000X
CA11307TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0113070Medicaid
200664396OtherFEDERAL ID NUMBER
CAZZZ29801ZMedicare ID - Type Unspecified
ZZZ29801ZMedicare PIN