1184614109 NPI number — MR. DONALD BRUCE KNAPP O.D.

Table of content: MR. DONALD BRUCE KNAPP O.D. (NPI 1184614109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184614109 NPI number — MR. DONALD BRUCE KNAPP O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNAPP
Provider First Name:
DONALD
Provider Middle Name:
BRUCE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184614109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2549 SULPHUR SPRINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAUQUOIT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13456-3217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-794-8657
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
392 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST WINFIELD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13491-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-822-5678
Provider Business Practice Location Address Fax Number:
315-822-5973
Provider Enumeration Date:
10/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  VUT003992-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0005109317 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010003992 . This is a "BLUEPOINT 2" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P017002202 . This is a "HMO BLUE OPTION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 16-1182665 . This is a "TRICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010003992 . This is a "EXCELLUS HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00667230 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16-1182665 . This is a "UNITED HEALTHCARE INSURAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161182665001 . This is a "TODAY'S OPTIONS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 161182665001 . This is a "AMERICAN PROGRESSIVE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 595113 . This is a "MVP HEALTH PLAN, INC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 16-1182665-002 . This is a "RMSCO, INC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P017002202 . This is a "MEDICARE BLUE PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 16-1182665 . This is a "EMPIRE PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 200055337 . This is a "MVP HEALTH PLAN, INC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N 1790859965 . This is a "FIRST AMERICAN LIFE INSUR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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