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506 Main St, Dallas, OR 97338-1915 | |
| (503) 623-9233 | |
| (503) 623-9233 |
| Full Name | |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 506 Main St, Dallas, Oregon |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760669733 | NPI | - | NPPES |
| 500690159 | Medicaid | OR | |
| 500695313 | Medicaid | OR | |
| 500641229 | Medicaid | OR | |
| 024687 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 1547T (Oregon) | Primary |
| Provider Name | Garrett W Knowles |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1790073856 PECOS PAC ID: 6305018409 Enrollment ID: I20111014000323 |
| Provider Name | Geoffrey Wade Knowles |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1285986513 PECOS PAC ID: 8729388285 Enrollment ID: I20151204002506 |
| Provider Name | Grant William Knowles |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1710362058 PECOS PAC ID: 9739484494 Enrollment ID: I20160218000997 |
| Mailing Address | Practice Location Address |
|---|---|
506 Main St, Dallas, OR 97338-1915 Ph: (503) 623-9233 | 506 Main St, Dallas, OR 97338-1915 Ph: (503) 623-9233 |
Gary Knowles, OD Optometrist Medicare: Medicare Enrolled Practice Location: 506 Main St, Dallas, OR 97338 Phone: 503-623-9233 Fax: 503-623-9233 | |
John L Barringer, Optometrist Medicare: Not Enrolled in Medicare Practice Location: 606 Sw Hayter St, Dallas, OR 97338 Phone: 503-949-5760 | |
Geoffrey Wade Knowles, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 506 Main St, Dallas, OR 97338 Phone: 503-851-2547 | |
Christopher David Johnson, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 986 Se Uglow Street, Dallas, OR 97338 Phone: 503-623-3538 Fax: 503-623-8112 |