Provider Demographics
NPI:1265522320
Name:LOUIE, KINGMAN JAY (OD)
Entity type:Individual
Prefix:
First Name:KINGMAN
Middle Name:JAY
Last Name:LOUIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COBBLELAKE CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4319
Mailing Address - Country:US
Mailing Address - Phone:916-392-8524
Mailing Address - Fax:916-392-8524
Practice Address - Street 1:7215 FLORIN MALL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2701
Practice Address - Country:US
Practice Address - Phone:916-421-3500
Practice Address - Fax:916-421-3572
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6733152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist