Healthcare Provider Details

I. General information

NPI: 1508954652
Provider Name (Legal Business Name): MICHAEL GEORGE YOUNES O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MAIN ST
EL CAJON CA
92020-4007
US

IV. Provider business mailing address

7565 CRESCENDO LN
SAN DIEGO CA
92127-3841
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2498
  • Fax:
Mailing address:
  • Phone: 313-485-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004250
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: