MEDICARE: DR. NATALIE ANN KNABB 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	4621	FL

General Provider Information

NPI Number	:	1215247390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATALIE ANN KNABB O.D

Provider Business Mailing Address
First Line	:	480 S 1ST ST
Second Line	:
City	:	MACCLENNY
State	:	FL
Zip	:	32063-2543
Country	:	US
Telephone Number	:	858-705-0092
Fax Number	:

Provider Business Practice Location Address
First Line	:	4890 BIG ISLAND DR STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7490
Country	:	US
Telephone Number	:	904-642-5658
Fax Number	:	904-564-2646

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

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	12/16/2021

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