Individual
DR. ANDREW GLEN KNEZICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1501 NEWCASTLE ST, BRUNSWICK, GA 31520-6806
(912) 280-0012
(912) 280-0991
Mailing address
90 VILLAGE AT GLYNN PLACE, BRUNSWICK, GA 31525
(912) 264-6000
(912) 280-0991
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT001803
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209089721A
—
GA
01
—
32774
AVESIS
GA
01
—
582646940
NVA
GA
01
—
6599375
GHI
GA
01
—
GA1803
EYE MED
GA
01
—
GK22894
SPECTERA
GA
01
—
POO149589
MEDICARE RAIL ROAD
GA
Enumeration date
11/28/2005
Last updated
10/12/2017
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