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General NPI Number Information
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NPI Number | 1942279708
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Entity Type | Individual
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Provider Name | TONYA VAUGHN
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Gender | Female
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 24800 CHAGRIN BLVD SUITE 211
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City | BEACHWOOD
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State | OH
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Zip | 44122-5648
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Country | US
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Telephone | 216-896-0316
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Fax | 216-896-9997
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Provider Business Mailing Address
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Address Line | 24800 CHAGRIN BLVD SUITE 211
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City | BEACHWOOD
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State | OH
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Zip | 44122-5648
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Country | US
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Telephone | 216-896-0316
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Fax | 216-896-9997
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 5656
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License Number State | OH
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