Provider Demographics
NPI:1245518323
Name:KNAPP, LAURA JEAN (OD)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEAN
Last Name:KNAPP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:SATKOFSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:17-10 FAIR LAWN AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2324
Mailing Address - Country:US
Mailing Address - Phone:201-794-7977
Mailing Address - Fax:
Practice Address - Street 1:17-10 FAIR LAWN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2324
Practice Address - Country:US
Practice Address - Phone:201-794-7977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-24
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002061152W00000X
NJ27OA00671000152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1245518323Medicaid
VAVV3597AMedicare PIN