Provider Demographics
NPI:1558091603
Name:KING, JOSHUA W
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:W
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 1:1725 W. EVERLY BROTHERS
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330
Mailing Address - Country:US
Mailing Address - Phone:270-754-4483
Mailing Address - Fax:270-754-4909
Practice Address - Street 1:1725 W. EVERLY BROTHERS
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330
Practice Address - Country:US
Practice Address - Phone:270-754-4483
Practice Address - Fax:270-754-4909
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY244589156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician