Provider Demographics
NPI:1659468502
Name:CAIN, KEVIN LEE (OD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEE
Last Name:CAIN
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 1:925 GRAY DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9357
Mailing Address - Country:US
Mailing Address - Phone:614-254-9851
Mailing Address - Fax:614-866-2024
Practice Address - Street 1:206 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-4122
Practice Address - Country:US
Practice Address - Phone:614-873-1003
Practice Address - Fax:614-866-2024
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHT2103152W00000X
OH5199152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT2109OtherTPA
OH5199OtherOPTOMETRY LICENSE
OHT2109OtherTPA