Provider Demographics
NPI:1265443907
Name:KNAPP EYECARE CENTER, INC
Entity type:Organization
Organization Name:KNAPP EYECARE CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-294-2421
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-0540
Mailing Address - Country:US
Mailing Address - Phone:419-294-2421
Mailing Address - Fax:419-294-2499
Practice Address - Street 1:212 E WYANDOT AVE
Practice Address - Street 2:
Practice Address - City:UPPER SANDSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-1432
Practice Address - Country:US
Practice Address - Phone:419-294-2421
Practice Address - Fax:419-294-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID NUMBER
OH=========OtherTAX ID NUMBER