Provider Demographics
NPI:1740223858
Name:KING, ALONA M (OD)
Entity Type:Individual
Prefix:
First Name:ALONA
Middle Name:M
Last Name:KING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 S WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5285
Mailing Address - Country:US
Mailing Address - Phone:208-529-2701
Mailing Address - Fax:208-525-9367
Practice Address - Street 1:760 S WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-5285
Practice Address - Country:US
Practice Address - Phone:208-529-2701
Practice Address - Fax:208-525-9367
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID820423183OtherEMPLOYER ID
ID0026409Medicaid
ID820423183OtherEMPLOYER ID
ID0026409Medicaid