Provider Demographics
NPI:1811196132
Name:MARJORIE J. KNOTTS, O.D., INC
Entity Type:Organization
Organization Name:MARJORIE J. KNOTTS, O.D., INC
Other - Org Name:KNOTTS OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:KNOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-259-4234
Mailing Address - Street 1:6326 RUCKER RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4889
Mailing Address - Country:US
Mailing Address - Phone:317-259-4234
Mailing Address - Fax:
Practice Address - Street 1:6326 RUCKER RD
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4889
Practice Address - Country:US
Practice Address - Phone:317-259-4234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002141B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN274830Medicare PIN