Healthcare Provider Details

I. General information

NPI: 1649336355
Provider Name (Legal Business Name): JOSEPH KEITH YOUNG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FAWNWOOD RD
SANDY HOOK CT
06482-1400
US

IV. Provider business mailing address

10 FAWNWOOD RD
SANDY HOOK CT
06482-1400
US

V. Phone/Fax

Practice location:
  • Phone: 203-364-1964
  • Fax:
Mailing address:
  • Phone: 203-364-1964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number002528
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number002528
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number002528
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number002528
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002528
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: