Provider Demographics
NPI:1922554542
Name:KNOWLES, TERRI (OD)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 BOYD LN
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:OR
Mailing Address - Zip Code:97361-1611
Mailing Address - Country:US
Mailing Address - Phone:503-838-1244
Mailing Address - Fax:
Practice Address - Street 1:9615 GRAND RONDE RD
Practice Address - Street 2:
Practice Address - City:GRAND RONDE
Practice Address - State:OR
Practice Address - Zip Code:97347-9712
Practice Address - Country:US
Practice Address - Phone:503-879-2097
Practice Address - Fax:503-879-1644
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4318ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist