Individual
LOUIS L KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
308 N BROADWAY, COWETA, OK 74429-2604
(918) 486-2146
(918) 486-4006
Mailing address
308 N BROADWAY, COWETA, OK 74429-2604
(918) 486-2146
(918) 486-4006
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OK924
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200015410C
—
OK
01
—
540010811
MEDICARE/RAILROAD
OK
Enumeration date
11/07/2006
Last updated
08/20/2009
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