Provider Demographics
NPI:1487779971
Name:KING EYE ASSOCIATES INC
Entity type:Organization
Organization Name:KING EYE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KING
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:228-327-2831
Mailing Address - Street 1:3429 NORTH 5TH ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564
Mailing Address - Country:US
Mailing Address - Phone:601-766-3800
Mailing Address - Fax:601-947-2709
Practice Address - Street 1:11228 HWY 63 S
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452
Practice Address - Country:US
Practice Address - Phone:601-766-3800
Practice Address - Fax:601-947-2709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS691152W00000X
MS0683152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C03344Medicare ID - Type UnspecifiedGROUP