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General NPI Number Information
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NPI Number | 1487779971
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Entity Type | Organization
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Legal Business Name | KING EYE ASSOCIATES INC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11228 HWY 63 S
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City | LUCEDALE
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State | MS
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Zip | 39452
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Country | US
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Telephone | 601-766-3800
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Fax | 601-947-2709
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Provider Business Mailing Address
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Address Line | 3429 NORTH 5TH ST
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564
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Country | US
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Telephone | 601-766-3800
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Fax | 601-947-2709
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILLIP LEE KING JR.
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Credential | OD
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Telephone | 228-327-2831
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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 | 691
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0683
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License Number State | MS
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