Provider Demographics
NPI:1417180209
Name:DR LAURIE ARCOLANO OD AND DR WILLIAM VAUGHAN OD PA
Entity Type:Organization
Organization Name:DR LAURIE ARCOLANO OD AND DR WILLIAM VAUGHAN OD PA
Other - Org Name:VILLAGE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:910-484-3030
Mailing Address - Street 1:2516 FORDHAM DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3642
Mailing Address - Country:US
Mailing Address - Phone:910-484-3030
Mailing Address - Fax:910-484-1333
Practice Address - Street 1:3526 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4554
Practice Address - Country:US
Practice Address - Phone:910-484-3030
Practice Address - Fax:910-484-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1314152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2347825Medicare PIN