Provider Demographics
NPI:1174145874
Name:DALUYIN, CATHERINE ROSE (OD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ROSE
Last Name:DALUYIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 W MALLARD CREEK CHURCH RD STE D
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-5800
Mailing Address - Country:US
Mailing Address - Phone:704-295-0123
Mailing Address - Fax:704-510-9239
Practice Address - Street 1:2424 W MALLARD CREEK CHURCH RD STE D
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-5800
Practice Address - Country:US
Practice Address - Phone:704-295-0123
Practice Address - Fax:704-510-9239
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNNH734AOtherMEDICARE PTAN
NCNNH734BOtherMEDICARE PTAN