Provider Demographics
NPI:1306823299
Name:KING, DONALD G (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:G
Last Name:KING
Suffix:
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 1:600 CHURCH ST S
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-1666
Mailing Address - Country:US
Mailing Address - Phone:304-372-2222
Mailing Address - Fax:304-372-4215
Practice Address - Street 1:600 CHURCH ST S
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1666
Practice Address - Country:US
Practice Address - Phone:304-372-2222
Practice Address - Fax:304-372-4215
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV637-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVT32546Medicare UPIN
WV0321020001Medicare NSC
WV9161951Medicare ID - Type Unspecified