Provider Demographics
NPI:1598051948
Name:KING, KYLE WESLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:WESLEY
Last Name:KING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1445
Mailing Address - Country:US
Mailing Address - Phone:812-424-4444
Mailing Address - Fax:
Practice Address - Street 1:213 MAIN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708
Practice Address - Country:US
Practice Address - Phone:812-424-4444
Practice Address - Fax:812-424-2200
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003672A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist