Provider Demographics
NPI:1225069792
Name:BIGHAM, KEVIN DWAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DWAYNE
Last Name:BIGHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:14617 LAWYERS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-3219
Mailing Address - Country:US
Mailing Address - Phone:704-893-0090
Mailing Address - Fax:704-893-0944
Practice Address - Street 1:14617 LAWYERS RD
Practice Address - Street 2:SUITE A
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-3219
Practice Address - Country:US
Practice Address - Phone:704-893-0090
Practice Address - Fax:704-893-0944
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1746152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
68011OtherBEACHSTREET
90703OtherMAMSI
NC890925EMedicaid
22.00365OtherUNITED HEALTHCARE
B9267OtherMEDCOST PREFERRED
DD2824OtherRAILROAD MEDICARE
0925EOtherBLUE CROSS BLUE SHIELD NC
803877OtherCOMMUNITY EYE
803877OtherPARTNERS MEDICARE
ND1746OtherVISION BENEFITS OF AMER
24119OtherAVESIS
ND1746OtherVISION BENEFITS OF AMER
DD2824OtherRAILROAD MEDICARE
803877OtherPARTNERS MEDICARE
22.00365OtherUNITED HEALTHCARE