Individual
DR. ELISABETH D KNIBB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
4200 RUSTY RD, SAINT LOUIS, MO 63128-1973
(314) 894-7951
Mailing address
8 BLACKWOLF RUN CT, WILDWOOD, MO 63040-1570
(636) 236-4824
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2003017172
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003017172
MISSOURI STATE LICENSE NUMBER
MO
Enumeration date
01/21/2012
Last updated
01/21/2012
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