Provider Demographics
NPI:1134975600
Name:MATTHEW W KNECHT LLC
Entity type:Organization
Organization Name:MATTHEW W KNECHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:KNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-979-8899
Mailing Address - Street 1:159 BENTLEY CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-7354
Mailing Address - Country:US
Mailing Address - Phone:541-979-8899
Mailing Address - Fax:
Practice Address - Street 1:3025 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1348
Practice Address - Country:US
Practice Address - Phone:503-362-5982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care