Provider Demographics
NPI:1457389090
Name:KING, DAVID L (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:KING
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 1:312 E CENTERVIEW ST
Mailing Address - Street 2:KING EYE CENTER
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023
Mailing Address - Country:US
Mailing Address - Phone:704-857-7697
Mailing Address - Fax:704-857-6732
Practice Address - Street 1:312 E CENTERVIEW STREET
Practice Address - Street 2:
Practice Address - City:CHINA GROVE
Practice Address - State:NC
Practice Address - Zip Code:28023
Practice Address - Country:US
Practice Address - Phone:704-857-7697
Practice Address - Fax:704-857-6732
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1248152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
140618OtherCLARITY VISION
NC8909491Medicaid
19264OtherPARTNERS MEDICARE CHOICE
09491OtherBLUE CROSS BLUE SHIELD
19264OtherCOMMUNITY EYE CARE
T65051Medicare UPIN
NC8909491Medicaid
140618OtherCLARITY VISION