Basic Information
| Provider Information | |||||||||
| NPI: | 1902054042 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAYTON | ||||||||
| FirstName: | ALVAH | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | IV | ||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1299 | ||||||||
| Address2: | |||||||||
| City: | TARBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278861299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528238295 | ||||||||
| FaxNumber: | 2528238552 | ||||||||
| Practice Location | |||||||||
| Address1: | 2807 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TARBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278861903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528238295 | ||||||||
| FaxNumber: | 2528238552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 12/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2109 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 5910531 | 05 | NC | MEDICAID | 093YJ | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | P00778488 | 01 | NC | RAILROAD MEDICARE | OTHER |