Provider Demographics
NPI:1942279708
Name:VAUGHN, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24800 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5648
Mailing Address - Country:US
Mailing Address - Phone:216-896-0316
Mailing Address - Fax:216-896-9997
Practice Address - Street 1:24800 CHAGRIN BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5648
Practice Address - Country:US
Practice Address - Phone:216-896-0316
Practice Address - Fax:216-896-9997
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5656156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH62383OtherDAVIS VISION
OH0188872Medicaid
OH00002660OtherWELLCARE
OH341883505026OtherCARESOURCE
OH0188872Medicaid