Individual
DR. KENNETH WILLIAM KING JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1480 E LINCOLN RD, IDAHO FALLS, ID 83401-2128
(208) 525-8686
(208) 525-8684
Mailing address
1480 E LINCOLN RD, IDAHO FALLS, ID 83401-2128
(208) 525-8686
(208) 525-8684
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
ODP0467
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002543100
—
ID
01
—
0605250001
DMERC
—
01
—
82052
BLUE SHIELD
ID
01
—
I-902428
CHAMPUS
—
Enumeration date
08/04/2005
Last updated
12/20/2013
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