Basic Information
| Provider Information | |||||||||
| NPI: | 1669660346 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 AVENUE K SE | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338804126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632943504 | ||||||||
| FaxNumber: | 8632990096 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 A RIDGE WAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAKE WALES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338597762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636762008 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TUV006979 | NY | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OPC 3520 | FL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.