Healthcare Provider Details

I. General information

NPI: 1720187172
Provider Name (Legal Business Name): VAUGHT EYE ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 MAIN ST
CONWAY SC
29526-3567
US

IV. Provider business mailing address

1406 MAIN STREET
CONWAY SC
29526-3567
US

V. Phone/Fax

Practice location:
  • Phone: 843-488-2020
  • Fax: 843-488-9659
Mailing address:
  • Phone: 843-488-2020
  • Fax: 843-488-9659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number754
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number754
License Number StateSC

VIII. Authorized Official

Name: DR. JAMES M VAUGHT
Title or Position: OWNER
Credential: O.D.
Phone: 843-488-2020