Healthcare Provider Details

I. General information

NPI: 1942279708
Provider Name (Legal Business Name): TONYA VAUGHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24800 CHAGRIN BLVD SUITE 211
BEACHWOOD OH
44122-5648
US

IV. Provider business mailing address

24800 CHAGRIN BLVD SUITE 211
BEACHWOOD OH
44122-5648
US

V. Phone/Fax

Practice location:
  • Phone: 216-896-0316
  • Fax: 216-896-9997
Mailing address:
  • Phone: 216-896-0316
  • Fax: 216-896-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number5656
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: