Basic Information
| Provider Information | |||||||||
| NPI: | 1225069792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIGHAM | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | DWAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14617 LAWYERS RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MATTHEWS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281043219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048930090 | ||||||||
| FaxNumber: | 7048930944 | ||||||||
| Practice Location | |||||||||
| Address1: | 14617 LAWYERS RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MATTHEWS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281043219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048930090 | ||||||||
| FaxNumber: | 7048930944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 12/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1746 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 68011 | 01 | BEACHSTREET | OTHER | 90703 | 01 | MAMSI | OTHER | 890925E | 05 | NC | MEDICAID | 22.00365 | 01 | UNITED HEALTHCARE | OTHER | B9267 | 01 | MEDCOST PREFERRED | OTHER | DD2824 | 01 | RAILROAD MEDICARE | OTHER | 0925E | 01 | BLUE CROSS BLUE SHIELD NC | OTHER | 803877 | 01 | COMMUNITY EYE | OTHER | 803877 | 01 | PARTNERS MEDICARE | OTHER | ND1746 | 01 | VISION BENEFITS OF AMER | OTHER | 24119 | 01 | AVESIS | OTHER |