Individual
DR. EVERETT LYLE KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D., F.A.A.O.
Contact information
Practice address
418 S 5TH ST, LARAMIE, WY 82070-3733
(307) 745-8554
(307) 755-5929
Mailing address
418 S 5TH ST, LARAMIE, WY 82070-3733
(307) 745-8554
(307) 755-5929
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
WYOMING 143T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104080400
—
WY
01
—
83-0324373
TAX ID
WY
Enumeration date
12/18/2005
Last updated
05/15/2014
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