Geoffrey Wade Knowles, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3613 ATI Issued in OR

Practice address

506 Main St
Dallas, OR 97338-1915

Phone

(503) 851-2547

NPI assigned

Oct 10, 2012

Last updated

Jul 24, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Polk Vision Clinics IncGroup PAC ID 9032297296, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Polk Vision Clinics Inc.

  dba Central Vision Clinic

  • Optometrist
  • Dallas, OR
  • NPI 1760669733
  Medicare reassignment Care Compare group Authorized official
• Waldport Eye Care LLC

  • Optometrist
  • Waldport, OR
  • NPI 1366633679
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1285986513",
    "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": "503-851-2547"
        },
        {
            "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": "503-851-2547"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "405 Boyd Ln",
            "address_purpose": "LOCATION",
            "city": "Monmouth",
            "state": "OR",
            "postal_code": "973611611",
            "country_code": "US",
            "telephone_number": "503-838-1244",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "525 W Willow St",
            "address_purpose": "LOCATION",
            "city": "Waldport",
            "state": "OR",
            "postal_code": "973943049",
            "country_code": "US",
            "telephone_number": "541-563-4100",
            "fax_number": "503-837-1047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KNOWLES",
        "first_name": "GEOFFREY",
        "middle_name": "WADE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-10",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3613 ATI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Edward King IV, PHARM-D
• Michael Joseph Kirkland, D.C.
• Bethany Patricia Kleiber, DPT
• Susan Marie Klein
• Gary Knowles, OD
• Anthony Koch, PMHNP
• Kathleen Koens
• Ami Korsunsky, M.A. COUNSELING
• Kimberli Ann Krenik, LPC
• Sloan Krueger

• Optometrist in Dallas, OR
• Providers in Dallas, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.