Provider Demographics
NPI:1033789763
Name:KING, JONATHAN ANDREW (OD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ANDREW
Last Name:KING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1493 E RIDGELINE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4947
Mailing Address - Country:US
Mailing Address - Phone:801-399-1149
Mailing Address - Fax:801-399-0248
Practice Address - Street 1:1483 E RIDGELINE DR STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4977
Practice Address - Country:US
Practice Address - Phone:801-399-1149
Practice Address - Fax:801-399-0248
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT18004279A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist