Provider Demographics
NPI:1215247390
Name:KNABB, NATALIE ANN (OD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:ANN
Last Name:KNABB
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 1:480 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2543
Mailing Address - Country:US
Mailing Address - Phone:858-705-0092
Mailing Address - Fax:
Practice Address - Street 1:4890 BIG ISLAND DR STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7490
Practice Address - Country:US
Practice Address - Phone:904-642-5658
Practice Address - Fax:904-564-2646
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4621152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist