Provider Demographics
NPI:1588634109
Name:VAUGHAN, WILLIAM H (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:VAUGHAN
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 1:3526 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4554
Mailing Address - Country:US
Mailing Address - Phone:910-423-8600
Mailing Address - Fax:
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:910-423-8600
Practice Address - Fax:910-484-1333
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1314152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909956Medicaid
NC0790960001Medicare NSC
NC8909956Medicaid