Provider Demographics
NPI:1053938530
Name:KING VISION OF TYLER LLC
Entity type:Organization
Organization Name:KING VISION OF TYLER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JESSIE JR.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-880-0011
Mailing Address - Street 1:2555 RUBY WAY 8102
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460
Mailing Address - Country:US
Mailing Address - Phone:970-880-0011
Mailing Address - Fax:
Practice Address - Street 1:2555 RUBY WAY 8102
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460
Practice Address - Country:US
Practice Address - Phone:970-880-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based