Provider Demographics
NPI:1063673788
Name:VAUGHN EYECARE, LLC
Entity Type:Organization
Organization Name:VAUGHN EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:401-295-5955
Mailing Address - Street 1:567 S COUNTY TRL
Mailing Address - Street 2:SUITE 305
Mailing Address - City:EXETER
Mailing Address - State:RI
Mailing Address - Zip Code:02822-3422
Mailing Address - Country:US
Mailing Address - Phone:401-295-5955
Mailing Address - Fax:401-295-4955
Practice Address - Street 1:567 S COUNTY TRL
Practice Address - Street 2:SUITE 305
Practice Address - City:EXETER
Practice Address - State:RI
Practice Address - Zip Code:02822-3422
Practice Address - Country:US
Practice Address - Phone:401-295-5955
Practice Address - Fax:401-295-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00525261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1518994342OtherINDIVIDUAL NPI #
RI1518994342OtherINDIVIDUAL NPI #