Provider Demographics
NPI:1144311887
Name:KING, JAMES H (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:KING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-1407
Mailing Address - Country:US
Mailing Address - Phone:931-296-2747
Mailing Address - Fax:931-296-2749
Practice Address - Street 1:502 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1407
Practice Address - Country:US
Practice Address - Phone:931-296-2747
Practice Address - Fax:931-296-2749
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000000771152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3594663Medicaid
TN0017482OtherBLUECROSS BLUESHIELD TN
TN0742010001OtherMEDICARE DMERC
TN410001341OtherMEDICARE RAILROAD CARRIER
TN410001341OtherMEDICARE RAILROAD CARRIER
TNT78780Medicare UPIN
TN3594663Medicaid