Provider Demographics
NPI:1194977595
Name:DR. ALAN E. KNOTEK, OPTOMETRIST
Entity type:Organization
Organization Name:DR. ALAN E. KNOTEK, OPTOMETRIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KNOTEK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-357-6880
Mailing Address - Street 1:29 S WEBSTER ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5356
Mailing Address - Country:US
Mailing Address - Phone:630-357-6880
Mailing Address - Fax:
Practice Address - Street 1:29 S WEBSTER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5356
Practice Address - Country:US
Practice Address - Phone:630-357-6880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL32244900OtherBCBS
IL154665OtherEYEMED
IL154665OtherEYEMED
IL0690100001Medicare NSC