Healthcare Provider Details

I. General information

NPI: 1063673788
Provider Name (Legal Business Name): VAUGHN EYECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 S COUNTY TRL SUITE 305
EXETER RI
02822-3422
US

IV. Provider business mailing address

567 S COUNTY TRL SUITE 305
EXETER RI
02822-3422
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-5955
  • Fax: 401-295-4955
Mailing address:
  • Phone: 401-295-5955
  • Fax: 401-295-4955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberODTG00525
License Number StateRI

VIII. Authorized Official

Name: DR. ROBERT G. VAUGHN JR.
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 401-295-5955