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General NPI Number Information
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NPI Number | 1457203614
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Entity Type | Organization
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Legal Business Name | KING'S VISION CENTER, LLC
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 1001 S DEFIANCE ST
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City | ARCHBOLD
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State | OH
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Zip | 43502-1617
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Country | US
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Telephone | 419-445-5436
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 S DEFIANCE ST
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City | ARCHBOLD
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State | OH
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Zip | 43502-1617
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Country | US
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Telephone | 419-445-5436
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACQUELYN G SHORT
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Credential | OD
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Telephone | 865-748-4244
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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 |
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License Number State |
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