Provider Demographics
NPI:1629022959
Name:LARE-KNAPPENBERGER, KRISTINE (OD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:LARE-KNAPPENBERGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:LARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:825 E GATE BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2136
Mailing Address - Country:US
Mailing Address - Phone:516-804-5200
Mailing Address - Fax:631-309-6461
Practice Address - Street 1:400 N 17TH ST
Practice Address - Street 2:STE 101
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:610-433-0450
Practice Address - Fax:610-433-4655
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000245152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA001224Medicare ID - Type Unspecified
U67584Medicare UPIN