MEDICARE: ROBERT ADAM YOUNG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT002818	GA

General Provider Information

NPI Number	:	1366857807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ADAM YOUNG O.D.

Provider Business Mailing Address
First Line	:	2730 PEACHTREE INDUSTRIAL BLVD STE 206
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-8628
Country	:	US
Telephone Number	:	404-793-3937
Fax Number	:	404-793-4040

Provider Business Practice Location Address
First Line	:	2730 PEACHTREE INDUSTRIAL BLVD STE 206
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-8628
Country	:	US
Telephone Number	:	404-793-3937
Fax Number	:	404-793-4040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	02/15/2021

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