Doctor Name: | GWENDOLYN J KING |
NPI Number: | 1164481123 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | OPTICIAN |
License Number: | DO2342 |
Business Practice Address: | 520 S Parrott Ave Okeechobee, FL - 349744345 |
Business Phone Number: | 8637634334 |
Business Fax Number: | 8637633226 |
Mailing Address: | 520 S Parrott Ave, OKEECHOBEE |
State: | FL |
Postal Code: | 349744345 |
Phone Number: | 8637634334 |
Fax Number: | 8637633226 |
NPI Enumeration Date: | 03/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | DO2342 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |