Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1215385026 |
---|---|
Provider Name | Matthew King |
First Address | Wichita, KS 67206-1042 |
Second Address | Wichita, KS 67206-1042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2016 |
Last Update Date | 02/06/2016 |