Provider Demographics
NPI:1841326964
Name:VAUGHN, BRANDY LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:LYNN
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:926 S CEDAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-4164
Mailing Address - Country:US
Mailing Address - Phone:217-428-3557
Mailing Address - Fax:
Practice Address - Street 1:106 W BARNETT AVE
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535-1117
Practice Address - Country:US
Practice Address - Phone:217-877-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2015-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009439152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU93706Medicare UPIN