Provider Demographics
NPI:1972641454
Name:KNIGHT VISION
Entity Type:Organization
Organization Name:KNIGHT VISION
Other - Org Name:DR. KNIGHT AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-698-7618
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:SEABECK
Mailing Address - State:WA
Mailing Address - Zip Code:98380-0609
Mailing Address - Country:US
Mailing Address - Phone:360-698-7618
Mailing Address - Fax:360-698-4145
Practice Address - Street 1:10315 SILVERDALE WAY NW
Practice Address - Street 2:SPACE J1
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7670
Practice Address - Country:US
Practice Address - Phone:360-698-7618
Practice Address - Fax:360-698-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT02600Medicare UPIN