Provider Demographics
NPI:1659780310
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:OWNER / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SEBORAH
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-477-2733
Mailing Address - Street 1:1005 UNDERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-3332
Mailing Address - Country:US
Mailing Address - Phone:478-477-2733
Mailing Address - Fax:
Practice Address - Street 1:1005 UNDERWOOD DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-3332
Practice Address - Country:US
Practice Address - Phone:478-477-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty