Provider Demographics
NPI:1700842341
Name:KNOTEK, ALAN E (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:E
Last Name:KNOTEK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 S WEBSTER ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5356
Mailing Address - Country:US
Mailing Address - Phone:630-357-6880
Mailing Address - Fax:630-357-6995
Practice Address - Street 1:29 S WEBSTER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5356
Practice Address - Country:US
Practice Address - Phone:630-357-6880
Practice Address - Fax:630-357-6995
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-006864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37702Medicare UPIN
IL672170Medicare PIN
0690100001Medicare NSC