Provider Demographics
NPI:1609257278
Name:KING, ROBERT BRUCE (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:KING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7455 IRMO DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8636
Mailing Address - Country:US
Mailing Address - Phone:803-781-2212
Mailing Address - Fax:
Practice Address - Street 1:7455 IRMO DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8636
Practice Address - Country:US
Practice Address - Phone:803-781-2212
Practice Address - Fax:803-233-2883
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist