MEDICARE: DR. HOLLY JEAN VAUGHT O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18003592A	IN

General Provider Information

NPI Number	:	1780813196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOLLY JEAN VAUGHT O.D.

Provider Business Mailing Address
First Line	:	105 QUEENS CT
Second Line	:
City	:	FRANKLIN
State	:	IN
Zip	:	46131-8927
Country	:	US
Telephone Number	:	812-844-0316
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 W JEFFERSON ST
Second Line	:
City	:	FRANKLIN
State	:	IN
Zip	:	46131-2124
Country	:	US
Telephone Number	:	317-736-7722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2009
Last Update Date	:	07/18/2018

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