MEDICARE: DR. KEVIN LEE CAIN O.D.

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	T2103	OH
2	152W00000X	Optometrist	5199	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	T2109	OTHER	OH	TPA
2	5199	OTHER	OH	OPTOMETRY LICENSE

General Provider Information

NPI Number	:	1659468502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN LEE CAIN O.D.

Provider Business Mailing Address
First Line	:	925 GRAY DR
Second Line	:
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-9357
Country	:	US
Telephone Number	:	614-254-9851
Fax Number	:	614-866-2024

Provider Business Practice Location Address
First Line	:	206 W MAIN ST
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-4122
Country	:	US
Telephone Number	:	614-873-1003
Fax Number	:	614-866-2024

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	04/29/2024

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