MEDICARE: DAVID L. KING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1248	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	2341185	OTHER	NC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0203X	OTHER	NC	BCBS
4	7000	OTHER	NC	PARTNERS

General Provider Information

NPI Number	:	1205043411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID L. KING

Provider Business Mailing Address
First Line	:	312 E CENTERVIEW ST
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023-2553
Country	:	US
Telephone Number	:	704-857-5464
Fax Number	:	704-857-6732

Provider Business Practice Location Address
First Line	:	312 E CENTERVIEW ST
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023-2553
Country	:	US
Telephone Number	:	704-857-7697
Fax Number	:	704-857-6732

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID KING
Credential	:	O.D.
Telephone Number	:	704-857-7697

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	11/09/2011

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Directions to “DAVID L. KING ” Practice Location

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