Provider Demographics
NPI:1790859965
Name:DONALD KNAPP
Entity Type:Organization
Organization Name:DONALD KNAPP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-866-3751
Mailing Address - Street 1:107 N PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1928
Mailing Address - Country:US
Mailing Address - Phone:315-866-3751
Mailing Address - Fax:315-866-3751
Practice Address - Street 1:107 N PROSPECT ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1928
Practice Address - Country:US
Practice Address - Phone:315-866-3751
Practice Address - Fax:315-866-3751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT003992-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00667230Medicaid
NY0169350001Medicare NSC
NY34441CMedicare ID - Type UnspecifiedMEDICARE NUMBER
NY00667230Medicaid
NY0169350002Medicare NSC