Healthcare Provider Details

I. General information

NPI: 1902088198
Provider Name (Legal Business Name): YOUNG EYES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 IBERIA ST
YOUNGSVILLE LA
70592-5738
US

IV. Provider business mailing address

PO BOX 1077
YOUNGSVILLE LA
70592-1077
US

V. Phone/Fax

Practice location:
  • Phone: 337-893-8976
  • Fax: 337-893-8972
Mailing address:
  • Phone: 337-857-5567
  • Fax: 337-857-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberMD.013947
License Number StateLA

VIII. Authorized Official

Name: MR. BYRON ANDREW YOUNG
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 337-857-5567