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General NPI Number Information
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NPI Number | 1568024230
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Entity Type | Individual
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Provider Name | LAWRENCE ALLEN KING III OD
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Gender | Male
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 06/28/2020
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Provider Practice Location Address
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Address Line | 4300 ROGERS AVE STE 46
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City | FORT SMITH
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State | AR
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Zip | 72903-3152
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Country | US
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Telephone | 479-785-0010
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Fax | 479-783-8478
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Provider Business Mailing Address
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Address Line | 4300 ROGERS AVE STE 46
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City | FORT SMITH
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State | AR
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Zip | 72903-3152
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Country | US
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Telephone | 479-785-0010
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Fax | 479-783-8478
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2803
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License Number State | AR
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