=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710028733
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD ORVILLE KING O. D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 W CAMP WISDOM RD SUITE 106
-----------------------------------------------------
City | DUNCANVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75116-3340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-296-2109
-----------------------------------------------------
Fax | 972-296-2109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6331 KNOLL RIDGE DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75249-3827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-296-2109
-----------------------------------------------------
Fax | 972-296-2109
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2240
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------