Provider Demographics
NPI:1902054042
Name:CAYTON, ALVAH C IV (OD)
Entity Type:Individual
Prefix:
First Name:ALVAH
Middle Name:C
Last Name:CAYTON
Suffix:IV
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:PO BOX 1299
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-1299
Mailing Address - Country:US
Mailing Address - Phone:252-823-8295
Mailing Address - Fax:252-823-8552
Practice Address - Street 1:2807 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-1903
Practice Address - Country:US
Practice Address - Phone:252-823-8295
Practice Address - Fax:252-823-8552
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2109152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910531Medicaid
NC093YJOtherBLUE CROSS BLUE SHIELD
NCP00778488OtherRAILROAD MEDICARE
NC5910531Medicaid
NCP00778488OtherRAILROAD MEDICARE
NC2023329Medicare PIN
NC2023329FMedicare PIN