Provider Demographics
NPI:1861474934
Name:KNOX, LEROY
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:
Last Name:KNOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-5864
Mailing Address - Country:US
Mailing Address - Phone:724-228-1028
Mailing Address - Fax:724-228-1946
Practice Address - Street 1:1500 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-5864
Practice Address - Country:US
Practice Address - Phone:724-228-1028
Practice Address - Fax:724-228-1946
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0510301804Medicaid