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General NPI Number Information
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NPI Number | 1942326244
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Entity Type | Organization
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Legal Business Name | ARKANSAS VISION DEVELOPMENT CENTER PA
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 1021 S WALDRON RD
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City | FORT SMITH
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State | AR
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Zip | 72903-2549
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Country | US
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Telephone | 479-478-8860
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Fax | 479-478-8890
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Provider Business Mailing Address
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Address Line | 1021 S WALDRON RD
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City | FORT SMITH
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State | AR
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Zip | 72903-2549
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Country | US
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Telephone | 479-478-8860
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Fax | 479-478-8890
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MRS. WANDA VAUGHN
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Credential | O.D
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Telephone | 479-478-8860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 2554
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License Number State | AR
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