Active NPI
Gary Knowles, OD
- Optometrist
- Dallas, OR
National Provider Identifier
1154364743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1547T
- Practice address
- 506 Main St
Dallas, OR 97338-1915 - Phone
- (503) 623-9233
- Fax
- (503) 623-9233
- NPI assigned
- Jun 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1547T | OR | Primary |
Addresses
Primary practice location
506 Main St
Dallas, OR 97338-1915
Mailing address
506 Main St
Dallas, OR 97338-1915
Phone (503) 623-9233
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 279018 | Medicaid | OR | |
| 0310568863 | Other | OR | EYE MED |
| 022775000 | Other | OR | BLUE CROSS |
| 7072090 | Other | OR | AETNA |
| 93093 | Other | OR | LIFEWISE |
| 002118501001 | Other | OR | CATERPILLAR |
| 93082710497338 | Other | OR | TRICARE |
| 31107 | Other | OR | UNITED MEDICAL RESOURCES |
| 93029 | Other | OR | PACIFIC SOURCE |
| O000790187 | Other | OR | MUTUAL OF OMAHA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1547T | OR | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228348800000",
"number": "1154364743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "506 MAIN ST",
"city": "DALLAS",
"state": "OR",
"postal_code": "973381915",
"telephone_number": "503-623-9233",
"fax_number": "503-623-9233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "506 MAIN ST",
"city": "DALLAS",
"state": "OR",
"postal_code": "973381915",
"telephone_number": "503-623-9233",
"fax_number": "503-623-9233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KNOWLES",
"first_name": "GARY",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-13",
"last_updated": "2008-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "1547T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "279018",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYE MED",
"identifier": "0310568863",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "022775000",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7072090",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LIFEWISE",
"identifier": "93093",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CATERPILLAR",
"identifier": "002118501001",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "93082710497338",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED MEDICAL RESOURCES",
"identifier": "31107",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PACIFIC SOURCE",
"identifier": "93029",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MUTUAL OF OMAHA",
"identifier": "O000790187",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.