Amy J. Knickerbocker, LLC
Organization Active NPI Optometrist · Hannibal, MO
NPI 1457763658 · NPPES record last updated May 22, 2014
Key facts
- NPI
- 1457763658
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 2000143624 (MO)
- Legal business name
- AMY J. KNICKERBOCKER, LLC
- Practice address
- 7 Oak Ridge Pond Rd
Hannibal, MO 63401-6539 - Phone
- (573) 406-5276
- Fax
- (573) 406-1503
- NPI assigned
- May 22, 2014
- Organization subpart
- No
Authorized official
- Name
- Dr. Amy Joanne Knickerbocker, O.D.
- Title
- Optometrist
- Phone
- (573) 406-5276
Practitioners 1
-
Amy Joanne Knickerbocker, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160817000504 | MO | Part B Supplier - Clinic/Group Practice | 0840585766 |
Receives reassigned benefits from 1 practitioner Practice locations: Hannibal, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 2000143624 | MO | Yes |
Addresses
Primary practice location
7 Oak Ridge Pond Rd
Hannibal, MO 63401-6539
Mailing address
3650 Stardust Dr
Hannibal, MO 63401-2480
Phone (573) 406-1503
Other providers in Hannibal, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.