Provider Demographics
NPI:1225448913
Name:DAVID R. KING, O.D., INC.
Entity Type:Organization
Organization Name:DAVID R. KING, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-896-3937
Mailing Address - Street 1:2020 HIGH ST STE I
Mailing Address - Street 2:2020 HIGH STREET STE. I
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3518
Mailing Address - Country:US
Mailing Address - Phone:559-896-3937
Mailing Address - Fax:
Practice Address - Street 1:1046 WHITLEY AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2324
Practice Address - Country:US
Practice Address - Phone:559-992-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10350TPLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7560040Medicaid
CADN6204Medicare PIN
CA3940310002Medicare NSC
CA7560040Medicaid