Healthcare Provider Details

I. General information

NPI: 1285225714
Provider Name (Legal Business Name): YOUNG PROFESSIONAL OPTOMETRY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39608 EUREKA DR
NEWARK CA
94560-4805
US

IV. Provider business mailing address

39608 EUREKA DR
NEWARK CA
94560-4805
US

V. Phone/Fax

Practice location:
  • Phone: 510-455-8168
  • Fax:
Mailing address:
  • Phone: 510-455-8168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ESTHER YOUNG
Title or Position: PRESIDENT
Credential: OD
Phone: 510-455-8168