Provider Demographics
NPI:1285691253
Name:KNOLLER, NAOMI R (OD)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:R
Last Name:KNOLLER
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 1:680 CAMPERDOWN RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2056
Mailing Address - Country:US
Mailing Address - Phone:201-287-1144
Mailing Address - Fax:201-287-0766
Practice Address - Street 1:40 SAW MILL RIVER RD
Practice Address - Street 2:WESTCHESTER OPHTHALMOLOGY - SUITE FB2
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1535
Practice Address - Country:US
Practice Address - Phone:914-579-2344
Practice Address - Fax:914-579-2346
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005003-1152W00000X, 152WC0802X, 152WL0500X
NJ04984152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01644182Medicaid
NYU39324Medicare UPIN
NYCOA372Medicare ID - Type Unspecified