Provider Demographics
NPI:1922148659
Name:KINGSLEY OPTICAL INC
Entity Type:Organization
Organization Name:KINGSLEY OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPR
Authorized Official - Prefix:
Authorized Official - First Name:ANGI
Authorized Official - Middle Name:SPURRIER
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-341-2908
Mailing Address - Street 1:8674 SKILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243
Mailing Address - Country:US
Mailing Address - Phone:214-341-2908
Mailing Address - Fax:214-341-2471
Practice Address - Street 1:8674 SKILLMAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:214-341-2908
Practice Address - Fax:214-341-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0969900001Medicare ID - Type Unspecified