MEDICARE: MRS. KEELY M KNOCHE OD

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	2427	CO

General Provider Information

NPI Number	:	1992790216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KEELY M KNOCHE OD

Provider Business Mailing Address
First Line	:	6005 DELMONICO DRIVE
Second Line	:	SUITE 140, ROCKRIMMON VISION CLINIC, P.C.
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-2264
Country	:	US
Telephone Number	:	719-522-9393
Fax Number	:	719-532-1114

Provider Business Practice Location Address
First Line	:	6005 DELMONICO DR
Second Line	:	SUITE 140, ROCKRIMMON VISION CLINIC, P.C.
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-2237
Country	:	US
Telephone Number	:	719-522-9393
Fax Number	:	719-532-1114

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	12/09/2010

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