Provider Demographics
NPI:1154432508
Name:KNOLLE & YOUNG ASSOCIATES PA
Entity type:Organization
Organization Name:KNOLLE & YOUNG ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZARMEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-472-4011
Mailing Address - Street 1:5656 BEE CAVE RD
Mailing Address - Street 2:SUITE F 200
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5280
Mailing Address - Country:US
Mailing Address - Phone:512-472-4011
Mailing Address - Fax:512-472-5057
Practice Address - Street 1:5656 BEE CAVE RD
Practice Address - Street 2:SUITE F 200
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5280
Practice Address - Country:US
Practice Address - Phone:512-472-4011
Practice Address - Fax:512-472-5057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1770534737OtherDR VENDAL INDIVIDUAL NPI
TX1558364224OtherDR DE SABRA INDIVIDUAL NP
TX1154432508OtherNPI
TX1083814511OtherDR KIM NPI
TX1770534737OtherDR VENDAL INDIVIDUAL NPI
TX00L63VMedicare PIN