Provider Demographics
NPI:1871725143
Name:KNOWLES, KIRSTEN JO (OD)
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:JO
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11289 63RD LN N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-1893
Mailing Address - Country:US
Mailing Address - Phone:503-851-0461
Mailing Address - Fax:
Practice Address - Street 1:11289 63RD LN N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33412-1893
Practice Address - Country:US
Practice Address - Phone:503-851-0461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7857152W00000X
OR3333ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist