Provider Demographics
NPI:1518994342
Name:VAUGHN, ROBERT GILBERT JR (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GILBERT
Last Name:VAUGHN
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SHADY HILL DR
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-2337
Mailing Address - Country:US
Mailing Address - Phone:401-212-7708
Mailing Address - Fax:
Practice Address - Street 1:639 METACOM AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-2348
Practice Address - Country:US
Practice Address - Phone:401-245-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI73733Medicare UPIN
RI419004545Medicare ID - Type Unspecified