Wallace John Knapp, O.D.
Individual provider Active NPI Optometrist · Upper Sandusky, OH
NPI 1477535383 · NPPES record last updated Apr 22, 2011
Key facts
- NPI
- 1477535383
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2913/T826 (OH)
- Practice address
- 212 E Wyandot Ave
Upper Sandusky, OH 43351-1432 - Phone
- (419) 294-2421
- Fax
- (419) 294-2499
- NPI assigned
- Nov 16, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2913 | OH | MD | Chiropractor |
| 2913/T826 | OH | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2913/T826 | OH | Yes |
Addresses
Primary practice location
212 E Wyandot Ave
Upper Sandusky, OH 43351-1432
Mailing address
PO Box 540
Upper Sandusky, OH 43351-0540
Phone (419) 294-2421
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0144114 | Medicaid | OH |
Other providers in Upper Sandusky, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.