Provider Demographics
NPI:1215531488
Name:KING VISION OF AUSTIN
Entity type:Organization
Organization Name:KING VISION OF AUSTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUDENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-526-8530
Mailing Address - Street 1:13867 VERA CRUZ RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-2563
Mailing Address - Country:US
Mailing Address - Phone:817-526-8530
Mailing Address - Fax:
Practice Address - Street 1:1804 MURRAY AVE
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2572
Practice Address - Country:US
Practice Address - Phone:855-664-6774
Practice Address - Fax:877-257-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based