Provider Demographics
NPI:1679639926
Name:KING, ROBERT L (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:KING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:495 WESTGATE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1833
Mailing Address - Country:US
Mailing Address - Phone:508-584-5151
Mailing Address - Fax:508-586-5382
Practice Address - Street 1:495 WESTGATE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1833
Practice Address - Country:US
Practice Address - Phone:508-584-5151
Practice Address - Fax:508-586-5382
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1894156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician