Provider Demographics
NPI:1043449713
Name:KING, REBECCA M (OD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:M
Last Name:KING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:201 SKYLINE DR STE 37
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-3500
Mailing Address - Country:US
Mailing Address - Phone:501-450-9191
Mailing Address - Fax:501-450-9922
Practice Address - Street 1:201 SKYLINE DR STE 37
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-3500
Practice Address - Country:US
Practice Address - Phone:501-450-9191
Practice Address - Fax:501-450-9922
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2625152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist