Provider Demographics
NPI:1285986513
Name:KNOWLES, GEOFFREY WADE (OD)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:WADE
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1915
Mailing Address - Country:US
Mailing Address - Phone:503-851-2547
Mailing Address - Fax:
Practice Address - Street 1:506 MAIN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1915
Practice Address - Country:US
Practice Address - Phone:503-851-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3613 ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist