Provider Demographics
NPI:1730275124
Name:KNAUER &SMITHWICK OPHTHALMOLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:KNAUER &SMITHWICK OPHTHALMOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:KNAUER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:904-388-6548
Mailing Address - Street 1:2535 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4710
Mailing Address - Country:US
Mailing Address - Phone:904-388-6548
Mailing Address - Fax:904-389-8157
Practice Address - Street 1:2535 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4710
Practice Address - Country:US
Practice Address - Phone:904-388-6548
Practice Address - Fax:904-389-8157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042581207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0694177-00Medicaid
FLK0705Medicare PIN
FLD61823Medicare UPIN
FL4469220001Medicare NSC