Provider Demographics
NPI:1710138060
Name:JO ANN G. KING,O.D. & ASSOCIATES
Entity Type:Organization
Organization Name:JO ANN G. KING,O.D. & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:251-666-3070
Mailing Address - Street 1:5245 RANGELINE SERVICE RD S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-9541
Mailing Address - Country:US
Mailing Address - Phone:251-666-3070
Mailing Address - Fax:251-661-9022
Practice Address - Street 1:5245 RANGELINE SERVICE RD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-9541
Practice Address - Country:US
Practice Address - Phone:251-666-3070
Practice Address - Fax:251-661-9022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JO ANN G. KING,O.D. & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS534TA272152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68919Medicare UPIN