Provider Demographics
NPI:1356360630
Name:KING, DOUGLAS C (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:C
Last Name:KING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2030 VIBORG RD
Mailing Address - Street 2:STE 105
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-3224
Mailing Address - Country:US
Mailing Address - Phone:805-245-6526
Mailing Address - Fax:
Practice Address - Street 1:2030 VIBORG RD
Practice Address - Street 2:105
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-3219
Practice Address - Country:US
Practice Address - Phone:805-688-6612
Practice Address - Fax:805-686-5822
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12937 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACS005ZMedicare PIN
CTDB3507OtherRAILROAD MEDICARE
CA1356360630OtherCIGNA
CTU83852Medicare UPIN
CT410001098Medicare ID - Type Unspecified
CT2V6357OtherHEALTH NET
CT56-2408052OtherNORTHEAST HMC PPO
CT090002553CT03OtherBC/BS ANTHEM
CT56-2408052OtherUNITED HEALTH CARE