Provider Demographics
NPI:1821099656
Name:CATINO, KELLY LYNNE (OD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNNE
Last Name:CATINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8116 MARKET ST
Mailing Address - Street 2:STE 100
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9732
Mailing Address - Country:US
Mailing Address - Phone:910-686-2074
Mailing Address - Fax:
Practice Address - Street 1:201 RACINE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8702
Practice Address - Country:US
Practice Address - Phone:910-395-6050
Practice Address - Fax:910-395-6692
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC410049393OtherRR MEDICARE INDIVIDUAL #
NC410049391OtherRR MEDICARE INDIVIDUAL #
NC89093MKMedicaid
NC093MKOtherBCBS PROV #
NC410049391OtherRR MEDICARE INDIVIDUAL #
NC093MKOtherBCBS PROV #
NC89093MKMedicaid
NC2472296AMedicare PIN
U92314Medicare UPIN