MEDICARE: CATHERINE ROSE DALUYIN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2635	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NNH734A	OTHER	NC	MEDICARE PTAN
2	NNH734B	OTHER	NC	MEDICARE PTAN

General Provider Information

NPI Number	:	1174145874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE ROSE DALUYIN OD

Provider Business Mailing Address
First Line	:	2424 W MALLARD CREEK CHURCH RD STE D
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-5800
Country	:	US
Telephone Number	:	704-295-0123
Fax Number	:	704-510-9239

Provider Business Practice Location Address
First Line	:	2424 W MALLARD CREEK CHURCH RD STE D
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-5800
Country	:	US
Telephone Number	:	704-295-0123
Fax Number	:	704-510-9239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2020
Last Update Date	:	11/26/2021

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