Provider Demographics
NPI:1275576282
Name:BAUGHAN, MICHAEL C (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:BAUGHAN
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 1:1813 W EHRINGHAUS ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4555
Mailing Address - Country:US
Mailing Address - Phone:252-333-1155
Mailing Address - Fax:252-333-1796
Practice Address - Street 1:1813 W EHRINGHAUS ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4555
Practice Address - Country:US
Practice Address - Phone:252-333-1155
Practice Address - Fax:252-333-1796
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1744152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093A0Medicaid
NC093A0OtherBCBSNC INDIVIDUAL NUMBER
NC093A0OtherBCBSNC INDIVIDUAL NUMBER
NC2471727AMedicare PIN
NCU02870Medicare UPIN