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General NPI Number Information
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NPI Number | 1518140672
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Entity Type | Organization
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Legal Business Name | CAROLINA EYE CARE OD PA
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 11/12/2012
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Provider Practice Location Address
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Address Line | 19607 W CATAWBA AVE
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City | CORNELIUS
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State | NC
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Zip | 28031-4002
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Country | US
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Telephone | 704-892-3542
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Fax | 704-896-8528
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Provider Business Mailing Address
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Address Line | 19607 W CATAWBA AVE
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City | CORNELIUS
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State | NC
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Zip | 28031-4002
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Country | US
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Telephone | 704-892-3542
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Fax | 704-896-8528
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Authorized Official
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Title or Position | PRESIDENT, CAROLINA EYE CARE
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Name | DR. KEVIN WAYNE LAFONE
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Credential | O.D.
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Telephone | 704-892-3542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1865
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License Number State | NC
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