MEDICARE: CAROLINA EYE CARE OD PA

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	1865	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE9560	OTHER	NC	RETIRED RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1266020004	OTHER	NC	DMERC REGION C

General Provider Information

NPI Number	:	1518140672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA EYE CARE OD PA

Provider Business Mailing Address
First Line	:	19607 W CATAWBA AVE
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-4002
Country	:	US
Telephone Number	:	704-892-3542
Fax Number	:	704-896-8528

Provider Business Practice Location Address
First Line	:	19607 W CATAWBA AVE
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-4002
Country	:	US
Telephone Number	:	704-892-3542
Fax Number	:	704-896-8528

Authorized Official
Title or Position	:	PRESIDENT, CAROLINA EYE CARE
Name	:	DR. KEVIN WAYNE LAFONE
Credential	:	O.D.
Telephone Number	:	704-892-3542

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	11/12/2012

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Directions to “CAROLINA EYE CARE OD PA ” Practice Location

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