Individual
GARY KNOWLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
506 MAIN ST, DALLAS, OR 97338-1915
(503) 623-9233
(503) 623-9233
Mailing address
506 MAIN ST, DALLAS, OR 97338-1915
(503) 623-9233
(503) 623-9233
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1547T
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002118501001
CATERPILLAR
OR
01
—
022775000
BLUE CROSS
OR
01
—
0310568863
EYE MED
OR
05
—
279018
—
OR
01
—
31107
UNITED MEDICAL RESOURCES
OR
01
—
7072090
AETNA
OR
01
—
93029
PACIFIC SOURCE
OR
01
—
93082710497338
TRICARE
OR
01
—
93093
LIFEWISE
OR
01
—
O000790187
MUTUAL OF OMAHA
OR
Enumeration date
06/13/2006
Last updated
12/04/2008
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