Provider Demographics
NPI:1497773311
Name:KNOBBE EYE CARE AND LASER CENTER, P.A.
Entity Type:Organization
Organization Name:KNOBBE EYE CARE AND LASER CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KNOBBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-416-6370
Mailing Address - Street 1:1014 MEMORIAL DR STE 312
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-2084
Mailing Address - Country:US
Mailing Address - Phone:903-416-6370
Mailing Address - Fax:903-416-6371
Practice Address - Street 1:1014 MEMORIAL DR STE 312
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-2084
Practice Address - Country:US
Practice Address - Phone:903-416-6370
Practice Address - Fax:903-416-6371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0871207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175548001Medicaid
OK100203920AMedicaid
TXDC2255OtherPALMETTO MEDICARE NUMBER
TX0047MAOtherBCBS GROUP NUMBER
TX00114XMedicare ID - Type UnspecifiedGROUP NUMBER
TXDC2255OtherPALMETTO MEDICARE NUMBER