Basic Information
| Provider Information | |||||||||
| NPI: | 1609902865 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNIGHT | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | OD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KNIGHT | ||||||||
| OtherFirstName: | ANNA | ||||||||
| OtherMiddleName: | R. | ||||||||
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| OtherCredential: | O.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1950 OLD GALLOWS RD STE 520 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 5712236780 | ||||||||
| Practice Location | |||||||||
| Address1: | 2425 LOCUST ST S | ||||||||
| Address2: | |||||||||
| City: | CANAL FULTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446149391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308541393 | ||||||||
| FaxNumber: | 3302667657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2007 | ||||||||
| LastUpdateDate: | 03/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3923 | OH | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.