MEDICARE: LARA ALICIA MCKNIGHT OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OD481	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00218425	OTHER	NV	RR #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649281403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA ALICIA MCKNIGHT OD

Provider Business Mailing Address
First Line	:	PO BOX 3186
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89702-3186
Country	:	US
Telephone Number	:	775-267-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4530 S CARSON ST STE 12
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-6914
Country	:	US
Telephone Number	:	775-267-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	12/03/2016

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Directions to “ LARA ALICIA MCKNIGHT OD” Practice Location

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