Active NPI
Elisabeth D Knibb, O.D.
- Optometrist
- Saint Louis, MO
National Provider Identifier
1912278060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2003017172
- Practice address
- 4200 Rusty Rd
Saint Louis, MO 63128-1973 - Phone
- (314) 894-7951
- NPI assigned
- Jan 21, 2012
- Last updated
- Jan 21, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 | 2003017172 | MO | Primary |
Addresses
Primary practice location
4200 Rusty Rd
Saint Louis, MO 63128-1973
Mailing address
8 Blackwolf Run CT
Wildwood, MO 63040-1570
Phone (636) 236-4824
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2003017172 | Other | MO | MISSOURI STATE LICENSE NUMBER |
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 |
|---|---|---|---|
| 2003017172 | MO | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prange Riley Optometrists, P.C. | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327104000000",
"number": "1912278060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8 BLACKWOLF RUN CT",
"city": "WILDWOOD",
"state": "MO",
"postal_code": "630401570",
"telephone_number": "636-236-4824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 RUSTY RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631281973",
"telephone_number": "314-894-7951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KNIBB",
"first_name": "ELISABETH",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-01-21",
"last_updated": "2012-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "2003017172",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISSOURI STATE LICENSE NUMBER",
"identifier": "2003017172",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.