Provider Demographics
NPI:1669660346
Name:KING, JULIA R (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:R
Last Name:KING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:407 AVENUE K SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4126
Mailing Address - Country:US
Mailing Address - Phone:863-294-3504
Mailing Address - Fax:863-299-0096
Practice Address - Street 1:2800 A RIDGE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-7762
Practice Address - Country:US
Practice Address - Phone:863-676-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006979152W00000X
FLOPC 3520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist