Provider Demographics
NPI:1205043411
Name:DAVID L. KING
Entity Type:Organization
Organization Name:DAVID L. KING
Other - Org Name:KING EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-857-7697
Mailing Address - Street 1:312 E CENTERVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023-2553
Mailing Address - Country:US
Mailing Address - Phone:704-857-5464
Mailing Address - Fax:704-857-6732
Practice Address - Street 1:312 E CENTERVIEW ST
Practice Address - Street 2:
Practice Address - City:CHINA GROVE
Practice Address - State:NC
Practice Address - Zip Code:28023-2553
Practice Address - Country:US
Practice Address - Phone:704-857-7697
Practice Address - Fax:704-857-6732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1248152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790203XMedicaid
NC0203XOtherBCBS
NC2341185OtherMEDICARE PTAN
NC7000OtherPARTNERS
NC0888100001Medicare NSC