Susan A Vaughan, O.D.
Individual provider Active NPI Optometrist · Colcord, OK
NPI 1124065479 · NPPES record last updated Oct 20, 2014
Key facts
- NPI
- 1124065479
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2026 (OK)
- Practice address
- 820 Stateline Rd
Colcord, OK 74338-1348 - Phone
- (918) 422-5811
- Fax
- (918) 422-5709
- NPI assigned
- Jun 2, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
820 Stateline Rd
Colcord, OK 74338-1348
Phone (918) 422-5811
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 11 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061012000665 | OK | Practitioner - Optometry | 7810993920 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2026 | AR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| My Family Eyecare, LTD., P.C. | Optometrist | Current |
Accepting new patients |
| Eye Center, PA | Optometrist | Past |
Accepting new patients |
Locations
820 Stateline Rd
West Siloam Springs, OK 74338
Phone (918) 422-5811
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2026 | OK | Yes |
| Optometrist | 152W00000X | 2405 | AR |
Addresses
Primary practice location
820 Stateline Rd
Colcord, OK 74338-1348
Mailing address
820 Stateline Rd
Colcord, OK 74338-1348
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100764550A | Medicaid | OK | |
| 117841722 | Medicaid | AR | |
| 6928350001 | Other | OK | CIGNA GOVERNEMENT SERVICES |
Other providers in Colcord, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.