Doctor Name: | GARY LEE VAUGHN |
NPI Number: | 1023290046 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | OPTICIAN |
License Number: | 941 |
Business Practice Address: | 622 Indian Trail Rd Indian Trail, NC - 28079 |
Business Phone Number: | 7048216700 |
Business Fax Number: | 7048218534 |
Mailing Address: | 622 Indian Trail Rd, INDIAN TRAIL |
State: | NC |
Postal Code: | 28079 |
Phone Number: | 7048216700 |
Fax Number: | 7048218534 |
NPI Enumeration Date: | 11/30/2007 |
NPI Last Update Date: | 11/30/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 941 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |