King, Kenneth William

King, Kenneth William is an sole proprietor health care provider with primary practice located at 1480 E Lincoln Rd , Idaho Falls ID 83401-2128. He recently has only one registered license in Eye and Vision Services Providers / Corneal and Contact Management, which is considered as his primary health care specialty. King, Kenneth William can be contacted via phone (208) 525-8686.

Contact Information

Primary practice address
1480 E Lincoln Rd Idaho Falls ID 83401-2128
Phone: (208) 525-8686
Fax: (208) 525-8684
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Corneal and Contact Management 152WC0802X ODP0467 Idaho

Profile Details

NPI number 1174524722
LBN Legal business name King, Kenneth William
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 4th, 2005
Last updated Dec 20th, 2013 - about 11 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174524722 NPPES
Other I-902428 CHAMPUS
Other 0605250001 CHAMPUS
Other 82052 CHAMPUS
MEDICAID 002543100 CHAMPUS

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