MEDICARE: FREDERICK WAYNE KNAPP JR. D.O.

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	207W00000X	Ophthalmology Physician	20A4950	CA

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	:	1972605939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK WAYNE KNAPP JR. D.O.

Provider Business Mailing Address
First Line	:	2420 VISTA WAY STE 101
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6190
Country	:	US
Telephone Number	:	760-722-5900
Fax Number	:	760-722-5999

Provider Business Practice Location Address
First Line	:	2420 VISTA WAY STE 101
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6190
Country	:	US
Telephone Number	:	760-722-5900
Fax Number	:	760-722-5999

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/08/2007

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