Provider Demographics
NPI:1568024230
Name:KING, LAWRENCE ALLEN III (OD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ALLEN
Last Name:KING
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4300 ROGERS AVE STE 46
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3152
Mailing Address - Country:US
Mailing Address - Phone:479-785-0010
Mailing Address - Fax:479-783-8478
Practice Address - Street 1:4300 ROGERS AVE STE 46
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3152
Practice Address - Country:US
Practice Address - Phone:479-785-0010
Practice Address - Fax:479-783-8478
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR2803152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist