Provider Demographics
NPI:1376710350
Name:DR, KINGMAN LOUIE
Entity Type:Organization
Organization Name:DR, KINGMAN LOUIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:MUGUAN
Authorized Official - Last Name:LEELOUIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-421-3500
Mailing Address - Street 1:7215 FLORIN MALL DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2701
Mailing Address - Country:US
Mailing Address - Phone:916-421-3500
Mailing Address - Fax:916-421-3572
Practice Address - Street 1:7215 FLORIN MALL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2701
Practice Address - Country:US
Practice Address - Phone:916-421-3500
Practice Address - Fax:916-421-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6733152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty