Provider Demographics
NPI:1386818235
Name:KING, ELIJHA DAVID (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ELIJHA
Middle Name:DAVID
Last Name:KING
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S CRAIG ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3734
Mailing Address - Country:US
Mailing Address - Phone:412-621-2523
Mailing Address - Fax:
Practice Address - Street 1:311 S CRAIG ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3734
Practice Address - Country:US
Practice Address - Phone:412-621-2523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02142912156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0728270001Medicare NSC