MEDICARE: DR. DALTON LEVI KINCAID 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	OPT.007069	OH

General Provider Information

NPI Number	:	1922747658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALTON LEVI KINCAID OD

Provider Business Mailing Address
First Line	:	262 NEIL AVE STE 320
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-7311
Country	:	US
Telephone Number	:	614-228-4500
Fax Number	:	614-221-0138

Provider Business Practice Location Address
First Line	:	262 NEIL AVE STE 320
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-7311
Country	:	US
Telephone Number	:	614-228-4500
Fax Number	:	614-221-0138

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	10/09/2023

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