Provider Demographics
NPI:1679911697
Name:VAUGHN, JAMEL DESHANE (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:JAMEL
Middle Name:DESHANE
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:6010 82ND ST STE 200
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-0822
Practice Address - Country:US
Practice Address - Phone:806-798-8820
Practice Address - Fax:806-798-9754
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8153152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist