Provider Demographics
NPI:1447818562
Name:KNEIP, TAYLOR ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:ALLEN
Last Name:KNEIP
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2446
Mailing Address - Country:US
Mailing Address - Phone:605-696-8870
Mailing Address - Fax:
Practice Address - Street 1:2311 YORKSHIRE DR
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2446
Practice Address - Country:US
Practice Address - Phone:605-696-8870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD390200000X
SD754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program