Provider Demographics
NPI:1730300104
Name:III KINGS INC.
Entity Type:Organization
Organization Name:III KINGS INC.
Other - Org Name:TRU-SITE OPTICAL CO., INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:215-237-4737
Mailing Address - Street 1:2801 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-2626
Mailing Address - Country:US
Mailing Address - Phone:215-226-0355
Mailing Address - Fax:215-226-1056
Practice Address - Street 1:1550 PRATT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-1923
Practice Address - Country:US
Practice Address - Phone:215-533-9392
Practice Address - Fax:215-533-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0852186Medicaid
PA083827Medicare ID - Type Unspecified
PAT72744Medicare UPIN