Active NPI
Kenneth William King Jr., O.D.
- Corneal and Contact Management Optometrist
- Idaho Falls, ID
National Provider Identifier
1174524722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Corneal and Contact Management Optometrist
- License
- ODP0467
- Practice address
- 1480 E Lincoln Rd
Idaho Falls, ID 83401-2128 - Phone
- (208) 525-8686
- Fax
- (208) 525-8684
- NPI assigned
- Aug 4, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Corneal and Contact Management Optometrist | 152WC0802X | ODP0467 | ID | Primary |
Addresses
Primary practice location
1480 E Lincoln Rd
Idaho Falls, ID 83401-2128
Mailing address
1480 E Lincoln Rd
Idaho Falls, ID 83401-2128
Phone (208) 525-8686
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| I-902428 | Other | CHAMPUS | |
| 0605250001 | Other | DMERC | |
| 82052 | Other | ID | BLUE SHIELD |
| 002543100 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ODP0467 | ID | MD | Corneal and Contact Management Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Porter Eyecare PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Idaho Falls, ID
- NPI 1770851446
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387497600000",
"number": "1174524722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1480 E LINCOLN RD",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834012128",
"telephone_number": "208-525-8686",
"fax_number": "208-525-8684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1480 E LINCOLN RD",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834012128",
"telephone_number": "208-525-8686",
"fax_number": "208-525-8684"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "KENNETH",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-04",
"last_updated": "2013-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "ID",
"license": "ODP0467",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "I-902428",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC",
"identifier": "0605250001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "82052",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002543100",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.