Provider Demographics
NPI:1992790216
Name:KNOCHE, KEELY M (OD)
Entity type:Individual
Prefix:MRS
First Name:KEELY
Middle Name:M
Last Name:KNOCHE
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:6005 DELMONICO DRIVE
Mailing Address - Street 2:SUITE 140, ROCKRIMMON VISION CLINIC, P.C.
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2264
Mailing Address - Country:US
Mailing Address - Phone:719-522-9393
Mailing Address - Fax:719-532-1114
Practice Address - Street 1:6005 DELMONICO DR
Practice Address - Street 2:SUITE 140, ROCKRIMMON VISION CLINIC, P.C.
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2237
Practice Address - Country:US
Practice Address - Phone:719-522-9393
Practice Address - Fax:719-532-1114
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO2427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC543158Medicare PIN
COV00433Medicare UPIN
COCE8003Medicare UPIN