Healthcare Provider Details

I. General information

NPI: 1417127291
Provider Name (Legal Business Name): LEROY KNOX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W CHESTNUT ST
WASHINGTON PA
15301-5864
US

IV. Provider business mailing address

1500 W CHESTNUT ST
WASHINGTON PA
15301-5864
US

V. Phone/Fax

Practice location:
  • Phone: 724-228-1028
  • Fax: 724-228-1946
Mailing address:
  • Phone: 724-228-1028
  • Fax: 724-228-1946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. LEROY KNOX
Title or Position: OWNER
Credential:
Phone: 724-228-1028