Provider Demographics
NPI:1932151875
Name:PAYNE, KEVIN GERALD (OD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:GERALD
Last Name:PAYNE
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 1:2402 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4421
Mailing Address - Country:US
Mailing Address - Phone:252-243-2020
Mailing Address - Fax:252-291-2020
Practice Address - Street 1:2402 MONTGOMERY DR
Practice Address - Street 2:WILSON EYE ASSOCIATES
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4421
Practice Address - Country:US
Practice Address - Phone:252-243-2020
Practice Address - Fax:252-291-2020
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1372152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909704Medicaid
410029823OtherRAILROAD MEDICARE
NC09704OtherBCBS NC
NC2280102OtherUNITED HEALTHCARE
70258OtherMEDCOST
PALMETTOOther0312480001
70258OtherMEDCOST
11606Medicare UPIN
NC0312480001Medicare NSC