Healthcare Provider Details

I. General information

NPI: 1184614109
Provider Name (Legal Business Name): DONALD BRUCE KNAPP O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 W MAIN ST
WEST WINFIELD NY
13491-2903
US

IV. Provider business mailing address

2549 SULPHUR SPRINGS RD
SAUQUOIT NY
13456-3217
US

V. Phone/Fax

Practice location:
  • Phone: 315-822-5678
  • Fax: 315-822-5973
Mailing address:
  • Phone: 315-794-8657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberVUT003992-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: