Provider Demographics
NPI:1245289149
Name:LAFONE, KEVIN WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WAYNE
Last Name:LAFONE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19607 W CATAWBA AVE
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19607 W CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4002
Practice Address - Country:US
Practice Address - Phone:704-892-3542
Practice Address - Fax:704-896-8528
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1865152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU93340Medicare UPIN
NC2472324CMedicare ID - Type Unspecified