Provider Demographics
NPI:1619289691
Name:KNAPKE, AMY TERESA (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:TERESA
Last Name:KNAPKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:TERESA
Other - Last Name:GEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6755 WENDY SUE ST
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3437
Mailing Address - Country:US
Mailing Address - Phone:419-852-1179
Mailing Address - Fax:
Practice Address - Street 1:245 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9404
Practice Address - Country:US
Practice Address - Phone:937-748-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5957152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist