MEDICARE: IVEY CAISON 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	2724	NC

General Provider Information

NPI Number	:	1841985595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVEY CAISON OD

Provider Business Mailing Address
First Line	:	PO BOX 1090
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-1090
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 S MAIN ST
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3320
Country	:	US
Telephone Number	:	336-227-4448
Fax Number	:

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

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	04/10/2023

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