Healthcare Provider Details

I. General information

NPI: 1205043411
Provider Name (Legal Business Name): DAVID L. KING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 E CENTERVIEW ST
CHINA GROVE NC
28023-2553
US

IV. Provider business mailing address

312 E CENTERVIEW ST
CHINA GROVE NC
28023-2553
US

V. Phone/Fax

Practice location:
  • Phone: 704-857-7697
  • Fax: 704-857-6732
Mailing address:
  • Phone: 704-857-5464
  • Fax: 704-857-6732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1248
License Number StateNC

VIII. Authorized Official

Name: DAVID KING
Title or Position: OWNER
Credential: O.D.
Phone: 704-857-7697