Provider Demographics
NPI:1275569279
Name:VAUGHN, CHAD ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ANTHONY
Last Name:VAUGHN
Suffix:
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 1:170 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-4555
Mailing Address - Country:US
Mailing Address - Phone:518-581-8595
Mailing Address - Fax:518-306-5291
Practice Address - Street 1:170 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4555
Practice Address - Country:US
Practice Address - Phone:518-306-5290
Practice Address - Fax:518-306-5291
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006630-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA9477Medicare UPIN