NPIMap

Organization Active NPI

Michelle King OD Inc a Professional Corporation

  • Optometrist
  • Poway, CA
National Provider Identifier
1609180603
Registry record updated Feb 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
13711 Issued in CA
Legal business name
MICHELLE KING OD INC A PROFESSIONAL CORPORATION
Practice address
14757 Pomerado Rd
Poway, CA 92064-2802
Phone
(858) 842-3006
Fax
(858) 842-3005
NPI assigned
Aug 2, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mary Michelle King, ODNPI 1578792107
Title
President
Phone
(858) 842-3006

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 13711 CA Primary

Addresses

Primary practice location

14757 Pomerado Rd
Poway, CA 92064-2802

Mailing address

14757 Pomerado Rd
Poway, CA 92064-2802
Phone (858) 842-3006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110315000060 CA Part B Supplier - Clinic/Group Practice 5496937393 Receives reassigned benefits from 14 practitioners
Practice locations: Poway, CA; El Cajon, CA

National Provider Directory

National Provider Directory

Locations

14757 Pomerado Rd
Poway, CA 92064
Phone (858) 842-3006

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424390400000",
    "number": "1609180603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14757 POMERADO RD",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642802",
            "telephone_number": "858-842-3006",
            "fax_number": "858-842-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14757 POMERADO RD",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642802",
            "telephone_number": "858-842-3006",
            "fax_number": "858-842-3005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHELLE KING OD INC A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-02",
        "last_updated": "2015-02-20",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-842-3006",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poway, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.