Individual
MR. JERRY A VAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
411 W. 39TH ST., KEARNEY, NE 68845
(308) 865-2760
(308) 865-2769
Mailing address
411 W. 39TH ST., KEARNEY, NE 68845
(308) 865-2760
(308) 865-2769
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
834
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025593300
—
NE
01
—
410016528
RAILROAD INDIV PROVIDER #
NE
05
—
47077269013
—
NE
01
—
6721
BLUE CROSS BLUE SHIELD NE
NE
Enumeration date
11/03/2005
Last updated
11/18/2009
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