Provider Demographics
NPI:1609045871
Name:KING OPTICIANS INC
Entity type:Organization
Organization Name:KING OPTICIANS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:RO
Authorized Official - Phone:401-732-4950
Mailing Address - Street 1:390 TOLL GATE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4326
Mailing Address - Country:US
Mailing Address - Phone:401-732-4950
Mailing Address - Fax:
Practice Address - Street 1:390 TOLL GATE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4326
Practice Address - Country:US
Practice Address - Phone:401-732-4950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOP00117156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0609045871Medicare UPIN
RI0213330001Medicare NSC