DR. JERRY LEE KING (NPI# 1417020462) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417020462 |
| Entity Type | Individual |
| Full Name | DR. JERRY LEE KING |
| Credential | O.D. |
| Practice Address |
103 W Loop 281 Ste 450 Longview TX 75605-4653 |
| Mailing Address |
103 W Loop 281 Suite 450 Longview TX 75605-4653 |
| Practice Telephone | 9036632020 |
| Practice Fax Number | 9036632353 |
| Mailing Telephone | 9036632020 |
| Mailing Fax Number | 9036632353 |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2008-07-23 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 2926TG | TX | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 093291502 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255506671 | Jerry N King | Surgery | 12731 S 83rd Ct, Palos Park, IL 60464-2026 | 2008-04-27 |
| 1346205689 | Jerry D King | Optometrist | 115 N Oak St, Eldon, MO 65026-1444 | 2006-04-19 |
| 1154465482 | Jerry Everett King | Radiology | 10180 Se Sunnyside Rd, Clackamas, OR 97015-8970 | 2007-02-19 |
| 1538101845 | Jerry R King | Counselor | 12 Medical Dr, Amarillo, TX 79106-4136 | 2006-06-12 |
| 1790754463 | Jerry J King | Physician Assistant | 2831 Fort Missoula Rd, Suite 232, Missoula, MT 59804-7419 | 2006-03-15 |
| 1669476396 | Jerry N King | Radiology | 4411 The 25 Way Ne, Ste 150, Albuquerque, NM 87109-5888 | 2005-06-10 |
| Street Address |
103 W LOOP 281 STE 450 |
| City | LONGVIEW |
| State | TX |
| Zip Code | 75605-4653 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396734802 | Ifeanyi Emmanuel Elueze | Internal Medicine | 103 W Loop 281, Suite 700, Longview, TX 75605-4653 | 2005-10-18 |
| 1821475591 | Bhh of Gregg County and Region, LLC | Home Health | 103 W Loop 281, Suite 440, Longview, TX 75605-4653 | 2015-05-01 |
| 1508020678 | Bobbi Jean Dodge | Physical Therapy Assistant | 103 W Loop 281, Suite 800, Longview, TX 75605-4653 | 2008-07-17 |
| 1437337011 | Brandon Ward Lambie | Physical Therapist | 103 W Loop 281, Suite 800, Longview, TX 75605-4653 | 2008-02-05 |
| 1174714737 | April Gatson, Md | Family Medicine | 103 W Loop 281, Suite 750, Longview, TX 75605-4653 | 2007-08-07 |
| 1083735328 | Kevin Johns | Physical Therapist | 103 W Loop 281, Suite 800, Longview, TX 75605-4653 | 2007-04-03 |
| 1518086024 | Orthodontic Centers of Texas | Dentist | 103 W Loop 281, Suite 462, Longview, TX 75605-4653 | 2007-03-28 |
| 1952429482 | Jane B. Ball | Physical Therapist | 103 W Loop 281, Longview, TX 75605-4653 | 2007-03-26 |
| 1417074055 | Kathryn Sue Langford | Occupational Therapist | 103 W Loop 281, Suite 800, Longview, TX 75605-4653 | 2007-03-26 |
| 1922123785 | Kyle Fitzgerald Lybarger | Physical Therapist | 103 W Loop 281, Longview, TX 75605-4653 | 2007-03-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194353730 | Dusty Rae Hane | Nurse Practitioner | Diagnostic Clinic of Longview, 2901 N Fourth St, Longview, TX 75605 | 2020-03-30 |
| 1831720374 | Kaycee Whatley | Nurse Practitioner | 323 W Hawkins Parkway, Longview, TX 75605 | 2020-02-03 |
| 1245733492 | Somers Pediatrics | Pediatrics | 103 W. Loop 281, Suite 474, Longview, TX 75605 | 2018-03-14 |
| 1467838391 | Piney Woods Er II LLC | Clinic/Center | 120 East Loop 281, Longview, TX 75605 | 2015-08-03 |
| 1386023968 | Elizabeth Ann Heeb Tidwell | Obstetrics & Gynecology | 802 Medical Dr Ste 100, Longview, TX 75605 | 2015-05-28 |
| 1215353651 | Tracy Hicks | Nurse Practitioner | 102 Commander Dr Ste 9, Longview, TX 75605 | 2014-03-10 |
| 1073881280 | Deirdre Scotter | Specialist/Technologist | 201 E Tomlinson Pkwy, Longview, TX 75605 | 2011-12-02 |
| 1316230139 | Traditions Hospice of Longview, LLC | Hospice Care, Community Based | 4362 N Us Hwy 259, Suite B, Longview, TX 75605 | 2011-05-26 |
| 1184916769 | Telema Dikibujiri Nga | Pediatrics | Longview Regional Medical Center, 2901 North Fourth Street, Longview, TX 75605 | 2011-05-13 |
| 1902101108 | The Veta Lewis Behavioral Health Group | Counselor | 1800 S. Judson St., Suite 100, Longview, TX 75605 | 2011-01-19 |
| Find all providers in zip 75605 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629547971 | Alex Soliz | Optometrist | 2304 Judson Rd Ste B, Longview, TX 75605-4674 | 2018-11-15 |
| 1700252640 | Gregory K. Wacasey Od Pllc | Optometrist | 2834 Bill Owens Pkwy, Longview, TX 75605-2102 | 2015-08-14 |
| 1942619275 | Blake Thomas Williams | Optometrist | 2394 H G Mosley Pkwy, Longview, TX 75604-3661 | 2014-08-12 |
| 1083979728 | Steven Daniel Barraza | Optometrist | 3098 N Eastman Rd, Longview, TX 75605-5176 | 2012-07-09 |
| 1427211416 | Rachel Lynnet Burnett | Optometrist | 1506 Judson Rd, Longview, TX 75601-3919 | 2008-07-09 |
| 1073712485 | Kristofer Kyle Thornton | Optometrist | 2500 Judson Rd Ste B, Longview, TX 75605-4640 | 2007-07-16 |
| 1477750081 | August Michael Wallace | Optometrist | 3032 N Eastman Rd Ste 100, Longview, TX 75605-5024 | 2007-06-27 |
| 1710046610 | Jeffrey S Tack | Optometrist | 820 Ocean Beach Hwy, Suite 100, Longview, WA 98632-4011 | 2006-12-06 |
| 1649368200 | William V Cheslock | Optometrist | 950 11th Ave, Longview, WA 98632-2504 | 2006-10-10 |
| 1437254539 | James H Mcdowell | Optometrist | 311b N High St, Longview, TX 75601-6336 | 2006-09-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.