MEDICARE: DR. SANDRA ANN KNUTSON 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	OD00003799	WA

General Provider Information

NPI Number	:	1023092400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA ANN KNUTSON O.D.

Provider Business Mailing Address
First Line	:	1306 57TH DR SE
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98092-8729
Country	:	US
Telephone Number	:	253-333-6955
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 BARNES BLVD
Second Line	:
City	:	MCCHORD AFB
State	:	WA
Zip	:	98438
Country	:	US
Telephone Number	:	253-982-2032
Fax Number	:

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/08/2007

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