Provider Demographics
NPI:1649365222
Name:KING, RICHARD (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
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 1:5782 QUIVER CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-2173
Mailing Address - Country:US
Mailing Address - Phone:513-892-5782
Mailing Address - Fax:513-896-6404
Practice Address - Street 1:1505 MAIN ST
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1079
Practice Address - Country:US
Practice Address - Phone:513-737-1594
Practice Address - Fax:513-737-1793
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2846152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist