Provider Demographics
NPI:1871535070
Name:VAUGHN, JODI A (OD)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:A
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6207 ANNA PARK DRIVE 203
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4371
Mailing Address - Country:US
Mailing Address - Phone:804-402-6386
Mailing Address - Fax:
Practice Address - Street 1:6207 ANNA PARK DRIVE 203
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4371
Practice Address - Country:US
Practice Address - Phone:804-402-6386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist