Provider Demographics
NPI:1972605939
Name:KNAPP, FREDERICK WAYNE JR (DO)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:WAYNE
Last Name:KNAPP
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 VISTA WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6190
Mailing Address - Country:US
Mailing Address - Phone:760-722-5900
Mailing Address - Fax:760-722-5999
Practice Address - Street 1:2420 VISTA WAY STE 101
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6190
Practice Address - Country:US
Practice Address - Phone:760-722-5900
Practice Address - Fax:760-722-5999
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4950207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX49500Medicaid
CA00AX49500Medicaid
CA20A4950Medicare ID - Type Unspecified