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General NPI Number Information
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NPI Number | 1124065479
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Entity Type | Individual
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Provider Name | SUSAN A VAUGHAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 820 STATELINE RD
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City | COLCORD
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State | OK
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Zip | 74338-1348
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Country | US
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Telephone | 918-422-5811
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Fax | 918-422-5709
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Provider Business Mailing Address
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Address Line | 820 STATELINE RD
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City | COLCORD
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State | OK
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Zip | 74338-1348
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2026
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2405
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License Number State | AR
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