MEDICARE: COURTNEY A KNESS O.D.

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	14107	CA
2	152W00000X	Optometrist	1356	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013295252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY A KNESS O.D.

Provider Business Mailing Address
First Line	:	74174 US HIGHWAY 183
Second Line	:
City	:	HOLDREGE
State	:	NE
Zip	:	68949-4052
Country	:	US
Telephone Number	:	619-252-8570
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 MCMILLAN ST
Second Line	:
City	:	HOLDREGE
State	:	NE
Zip	:	68949-2052
Country	:	US
Telephone Number	:	308-995-8697
Fax Number	:	908-995-6931

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

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	10/17/2012

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Directions to “ COURTNEY A KNESS O.D.” Practice Location

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