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General NPI Number Information
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NPI Number | 1609180603
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Entity Type | Organization
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Legal Business Name | MICHELLE KING OD INC A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 02/20/2015
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Provider Practice Location Address
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Address Line | 14757 POMERADO RD
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City | POWAY
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State | CA
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Zip | 92064-2802
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Country | US
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Telephone | 858-842-3006
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Fax | 858-842-3005
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Provider Business Mailing Address
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Address Line | 14757 POMERADO RD
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City | POWAY
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State | CA
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Zip | 92064-2802
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Country | US
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Telephone | 858-842-3006
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Fax | 858-842-3005
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY MICHELLE KING
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Credential | OD
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Telephone | 858-842-3006
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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 | 13711
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License Number State | CA
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