Provider Demographics
NPI:1851399281
Name:KNOUSE, JOHN DOYLE (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DOYLE
Last Name:KNOUSE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:PA
Mailing Address - Zip Code:18917-2108
Mailing Address - Country:US
Mailing Address - Phone:215-249-3937
Mailing Address - Fax:
Practice Address - Street 1:174 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:PA
Practice Address - Zip Code:18917-2108
Practice Address - Country:US
Practice Address - Phone:215-249-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-10
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000936152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00859467OtherRAILROAD MEDICARE
PA0937640001Medicare NSC
PA541830Medicare PIN