Provider Demographics
NPI:1508925330
Name:KING FAMILY EYE CARE, LLC
Entity Type:Organization
Organization Name:KING FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-388-9300
Mailing Address - Street 1:761 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2126
Mailing Address - Country:US
Mailing Address - Phone:860-388-9300
Mailing Address - Fax:860-396-2885
Practice Address - Street 1:761 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2126
Practice Address - Country:US
Practice Address - Phone:860-388-9300
Practice Address - Fax:860-396-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT2553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT50KINGEYECT01OtherANTHEM BCBS
CTC03048Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER