Provider Demographics
NPI:1245214147
Name:KING, FRED G JR (OD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:G
Last Name:KING
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203
Mailing Address - Country:US
Mailing Address - Phone:336-625-4241
Mailing Address - Fax:336-625-9488
Practice Address - Street 1:207 E SALISBURY ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203
Practice Address - Country:US
Practice Address - Phone:336-625-4241
Practice Address - Fax:336-625-9488
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1440152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist