Provider Demographics
NPI:1144204579
Name:HAYWOOD, CARLYLE DUKES JR
Entity Type:Individual
Prefix:DR
First Name:CARLYLE
Middle Name:DUKES
Last Name:HAYWOOD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 ALBEMARLE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-3206
Mailing Address - Country:US
Mailing Address - Phone:910-576-7371
Mailing Address - Fax:910-576-7372
Practice Address - Street 1:326 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-3206
Practice Address - Country:US
Practice Address - Phone:910-576-7371
Practice Address - Fax:910-576-7372
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1566152W00000X
PAOE007726P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890925KMedicaid
NC410043489OtherRR MEDICARE
NC0925KOtherBCBS
NC2471739OtherMEDICARE PTAN
NC890925KMedicaid
NCU-56546Medicare UPIN