Healthcare Provider Details

I. General information

NPI: 1285691253
Provider Name (Legal Business Name): NAOMI R KNOLLER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SAW MILL RIVER RD WESTCHESTER OPHTHALMOLOGY - SUITE FB2
HAWTHORNE NY
10532-1535
US

IV. Provider business mailing address

680 CAMPERDOWN RD
TEANECK NJ
07666-2056
US

V. Phone/Fax

Practice location:
  • Phone: 914-579-2344
  • Fax: 914-579-2346
Mailing address:
  • Phone: 201-287-1144
  • Fax: 201-287-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT005003-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number04984
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberT005003-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberT005003-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number04984
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: