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General NPI Number Information
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NPI Number | 1376710350
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Entity Type | Organization
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Legal Business Name | DR, KINGMAN LOUIE
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 7215 FLORIN MALL DR
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City | SACRAMENTO
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State | CA
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Zip | 95823-2701
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Country | US
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Telephone | 916-421-3500
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Fax | 916-421-3572
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Provider Business Mailing Address
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Address Line | 7215 FLORIN MALL DR
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City | SACRAMENTO
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State | CA
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Zip | 95823-2701
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Country | US
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Telephone | 916-421-3500
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Fax | 916-421-3572
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ROXANNE MUGUAN LEELOUIE
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Credential | O.D.
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Telephone | 916-421-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6733
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License Number State | CA
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