Provider Demographics
NPI:1881885515
Name:JOHN B. KNIGHT OD
Entity type:Organization
Organization Name:JOHN B. KNIGHT OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-733-4861
Mailing Address - Street 1:2012 THUNDERING HERD DR.
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-2715
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:25504-2715
Practice Address - Country:US
Practice Address - Phone:304-733-4861
Practice Address - Fax:304-733-2873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV761D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV180003317OtherUNITED HEALTHCARE
WVT32605Medicare UPIN
WV9287931Medicare PIN
WV180003317OtherUNITED HEALTHCARE
WV0613990001Medicare NSC