Jerry D King, O.D.
Individual provider Active NPI Optometrist · Eldon, MO
NPI 1346205689 · NPPES record last updated Jul 7, 2008
Key facts
- NPI
- 1346205689
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- TO2349 (MO)
- Practice address
- 115 N Oak St
Eldon, MO 65026-1444 - Phone
- (573) 392-7126
- Fax
- (573) 392-0800
- NPI assigned
- Apr 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TO2349 | MO | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TO2349 | MO | Yes |
Addresses
Primary practice location
115 N Oak St
Eldon, MO 65026-1444
Mailing address
115 N Oak St
Eldon, MO 65026-1444
Phone (573) 392-7126
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 310039805 | Medicaid | MO |
Other providers in Eldon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.