Provider Demographics
NPI:1720187172
Name:VAUGHT EYE ASSOCIATES, PA
Entity Type:Organization
Organization Name:VAUGHT EYE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-488-2020
Mailing Address - Street 1:1406 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3567
Mailing Address - Country:US
Mailing Address - Phone:843-488-2020
Mailing Address - Fax:843-488-9659
Practice Address - Street 1:1406 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3567
Practice Address - Country:US
Practice Address - Phone:843-488-2020
Practice Address - Fax:843-488-9659
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAUGHT EYE ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC754152W00000X, 332H00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC4081Medicaid
SCPC4081Medicaid
SC0269100001Medicare NSC