Provider Demographics
NPI:1962508945
Name:DAVID R. KING, O.D., INC.
Entity Type:Organization
Organization Name:DAVID R. KING, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-896-3937
Mailing Address - Street 1:2020 HIGH ST
Mailing Address - Street 2:STE I
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3518
Mailing Address - Country:US
Mailing Address - Phone:559-896-3937
Mailing Address - Fax:559-896-3090
Practice Address - Street 1:2020 HIGH ST
Practice Address - Street 2:STE I
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3518
Practice Address - Country:US
Practice Address - Phone:559-896-3937
Practice Address - Fax:559-896-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10350TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0103500Medicaid
CASD0103500Medicaid
CADN6204Medicare PIN
CA3940310001Medicare NSC
CASD0103500Medicare ID - Type Unspecified