Healthcare Provider Details

I. General information

NPI: 1871725143
Provider Name (Legal Business Name): KIRSTEN JO KNOWLES O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 01/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11289 63RD LN N
WEST PALM BEACH FL
33412-1893
US

IV. Provider business mailing address

11289 63RD LN N
WEST PALM BEACH FL
33412-1893
US

V. Phone/Fax

Practice location:
  • Phone: 503-851-0461
  • Fax:
Mailing address:
  • Phone: 503-851-0461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7857
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: