King, Jerry Lee
King, Jerry Lee is an sole proprietor health care provider with primary practice located at 103 W Loop 281 Ste 450, Longview TX 75605-4653. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. King, Jerry Lee can be contacted via phone (903) 663-2020.Contact Information
Primary practice address
103 W Loop 281 Ste 450
Longview TX 75605-4653
Phone: (903) 663-2020
Fax: (903) 663-2353
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2926TG | Texas |
Profile Details
| NPI number | 1417020462 |
|---|---|
| LBN Legal business name | King, Jerry Lee |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 16th, 2006 |
| Last updated | Jul 23rd, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417020462 | NPPES |
| Texas | MEDICAID | 093291502 |
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