Healthcare Provider Details

I. General information

NPI: 1326359886
Provider Name (Legal Business Name): HOLLY T YOUNG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY T YOUNG O.D.

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 MONTCLAIR RD SUITE 100
BIRMINGHAM AL
35213-1966
US

IV. Provider business mailing address

790 MONTCLAIR RD SUITE 100
BIRMINGHAM AL
35213-1966
US

V. Phone/Fax

Practice location:
  • Phone: 205-592-3911
  • Fax: 205-592-3537
Mailing address:
  • Phone: 205-592-3911
  • Fax: 205-592-3537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberSC39
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: