Provider Demographics
NPI:1598055188
Name:KNOX EYECARE
Entity Type:Organization
Organization Name:KNOX EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-233-5096
Mailing Address - Street 1:1030 ALABAR AVE.
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701
Mailing Address - Country:US
Mailing Address - Phone:319-233-5096
Mailing Address - Fax:319-287-9022
Practice Address - Street 1:1030 ALABAR AVE.
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701
Practice Address - Country:US
Practice Address - Phone:319-233-5096
Practice Address - Fax:319-287-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA952658OtherEYEMED
IA1598055188OtherUNITED HEALTHCARE
IAIB2167001OtherMEDICARE PTAN INDIVIDUAL
IA62742OtherAVESIS
IAIB2167OtherMEDICARE PTAN ORGANIZATION
1598055188OtherWELLMARK BC/BS
IA69203OtherDAVIS VISION
IA1598055188Medicaid