Organization
ARKANSAS VISION DEVELOPMENT CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WANDA VAUGHN O.D (OPTOMETRIST)
(479) 478-8860
Entity
Organization
Contact information
Practice address
1021 S WALDRON RD, FORT SMITH, AR 72903-2549
(479) 478-8860
(479) 478-8890
Mailing address
1021 S WALDRON RD, FORT SMITH, AR 72903-2549
(479) 478-8860
(479) 478-8890
Taxonomy
Speciality
Code
Description
License number
State
152WV0400X
Vision Therapy Optometrist
Primary
2554
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447387170
NPI INDIVIDUAL
AR
05
—
158686722
—
AR
01
—
1942326244
NPI GROUP
AR
05
—
200055390A
—
OK
05
—
200057240A
—
OK
01
—
49907
MEDICARE PTAN
AR
01
—
5F232
GROUP PTAN
AR
Enumeration date
03/21/2007
Last updated
04/16/2025
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