Individual
DR. SUSAN A VAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
820 STATELINE RD, COLCORD, OK 74338-1348
(918) 422-5811
(918) 422-5709
Mailing address
820 STATELINE RD, COLCORD, OK 74338-1348
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2026
OK
152W00000X
Optometrist
2405
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100764550A
—
OK
05
—
117841722
—
AR
01
—
6928350001
CIGNA GOVERNEMENT SERVICES
OK
Enumeration date
06/02/2006
Last updated
10/20/2014
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