MEDICARE: DR. KELLY LYNNE CATINO O.D.

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	1857	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410049393	OTHER	NC	RR MEDICARE INDIVIDUAL #
2	410049391	OTHER	NC	RR MEDICARE INDIVIDUAL #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	093MK	OTHER	NC	BCBS PROV #

General Provider Information

NPI Number	:	1821099656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY LYNNE CATINO O.D.

Provider Business Mailing Address
First Line	:	8116 MARKET ST
Second Line	:	STE 100
City	:	WILMINGTON
State	:	NC
Zip	:	28411-9732
Country	:	US
Telephone Number	:	910-686-2074
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 RACINE DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-8702
Country	:	US
Telephone Number	:	910-395-6050
Fax Number	:	910-395-6692

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/06/2020

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Directions to “ DR. KELLY LYNNE CATINO O.D.” Practice Location

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