Provider Demographics
NPI:1053041384
Name:KING, THOMAS DARRELL
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DARRELL
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-4989
Mailing Address - Country:US
Mailing Address - Phone:270-886-9826
Mailing Address - Fax:270-886-9859
Practice Address - Street 1:300 CLINIC DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4989
Practice Address - Country:US
Practice Address - Phone:270-886-9826
Practice Address - Fax:270-886-9859
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY111768156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician