Healthcare Provider Details

I. General information

NPI: 1659468502
Provider Name (Legal Business Name): KEVIN LEE CAIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W MAIN ST
PLAIN CITY OH
43064-4122
US

IV. Provider business mailing address

925 GRAY DR
PICKERINGTON OH
43147-9357
US

V. Phone/Fax

Practice location:
  • Phone: 614-873-1003
  • Fax: 614-866-2024
Mailing address:
  • Phone: 614-254-9851
  • Fax: 614-866-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT2103
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5199
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierT2109
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerTPA
# 2
Identifier5199
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerOPTOMETRY LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: