Provider Demographics
NPI:1134838667
Name:KING, LATORIAN (OD)
Entity type:Individual
Prefix:
First Name:LATORIAN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 N LOOP 1604 W APT 2209
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3594
Mailing Address - Country:US
Mailing Address - Phone:210-900-7496
Mailing Address - Fax:
Practice Address - Street 1:707 N HIGHWAY 67 STE 150
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2178
Practice Address - Country:US
Practice Address - Phone:972-299-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10756152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist