Healthcare Provider Details

I. General information

NPI: 1225654932
Provider Name (Legal Business Name): CAITLIN DAVIS WOLFORD OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN PAIGE DAVIS

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 RACINE DR
WILMINGTON NC
28403-8702
US

IV. Provider business mailing address

1950 OLD GALLOWS RD STE 520
VIENNA VA
22182-3970
US

V. Phone/Fax

Practice location:
  • Phone: 910-395-6050
  • Fax: 910-794-2222
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberPENDING
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2616
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: