Provider Demographics
NPI:1780243097
Name:KING VISION LLC
Entity type:Organization
Organization Name:KING VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OPTOMETERIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:LASHAWN
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:936-569-2015
Mailing Address - Street 1:2304 CAROLE ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2267
Mailing Address - Country:US
Mailing Address - Phone:954-261-1026
Mailing Address - Fax:936-398-6912
Practice Address - Street 1:4810 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1876
Practice Address - Country:US
Practice Address - Phone:954-261-1026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty