Provider Demographics
NPI:1568675924
Name:DEAN E. KING, O.D.
Entity Type:Organization
Organization Name:DEAN E. KING, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-658-9409
Mailing Address - Street 1:900 E MORTON PL
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4529
Mailing Address - Country:US
Mailing Address - Phone:951-658-9409
Mailing Address - Fax:951-658-2057
Practice Address - Street 1:900 E MORTON PL
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4529
Practice Address - Country:US
Practice Address - Phone:951-658-9409
Practice Address - Fax:951-658-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5416T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32688ZMedicare ID - Type UnspecifiedMEDICARE GROUP #