Provider Demographics
NPI:1972666030
Name:KNIGHT, JOHN B (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:KNIGHT
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 1:2012 THUNDERING HERD DR.
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504
Mailing Address - Country:US
Mailing Address - Phone:304-733-4861
Mailing Address - Fax:304-733-2873
Practice Address - Street 1:2012 THUNDERING HERD DR.
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504
Practice Address - Country:US
Practice Address - Phone:304-733-4861
Practice Address - Fax:304-733-2873
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV761D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000765036OtherBLUE CROSS BLUE SHIELD
WV0149305000Medicaid
WV180003317OtherUNITED HEALTHCARE
WV761DOtherLICENSE
WV0149305000Medicaid
WV0613990001Medicare NSC
WV0816261Medicare PIN
WV000765036OtherBLUE CROSS BLUE SHIELD