Active NPI
Dalton McGaugh
- Optometrist
- Fayetteville, AR
National Provider Identifier
1053164210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3269
- Practice address
- 1100 N College Ave
Fayetteville, AR 72703-1944 - Phone
- (479) 444-5093
- NPI assigned
- Apr 8, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Optometrist | 152W00000X | 3269 | OK | Primary |
Addresses
Primary practice location
1100 N College Ave
Fayetteville, AR 72703-1944
Mailing address
31807 W 157TH St
Excelsior Springs, MO 64024-5221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3269 | OK | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722124800000",
"number": "1053164210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31807 W 157TH ST",
"city": "EXCELSIOR SPRINGS",
"state": "MO",
"postal_code": "640245221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 N COLLEGE AVE",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727031944",
"telephone_number": "479-444-5093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCGAUGH",
"first_name": "DALTON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-04-08",
"last_updated": "2024-07-28",
"certification_date": "2024-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OK",
"license": "3269",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.