Provider Demographics
NPI:1922747658
Name:KINCAID, DALTON LEVI (OD)
Entity Type:Individual
Prefix:DR
First Name:DALTON
Middle Name:LEVI
Last Name:KINCAID
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:262 NEIL AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7311
Mailing Address - Country:US
Mailing Address - Phone:614-228-4500
Mailing Address - Fax:614-221-0138
Practice Address - Street 1:262 NEIL AVE STE 320
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7311
Practice Address - Country:US
Practice Address - Phone:614-228-4500
Practice Address - Fax:614-221-0138
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist