Healthcare Provider Details

I. General information

NPI: 1568873123
Provider Name (Legal Business Name): BECKY YEUNG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3777 COON RAPIDS BLVD NW SUITE 100
COON RAPIDS MN
55433-2630
US

IV. Provider business mailing address

3777 COON RAPIDS BLVD NW SUITE 100
COON RAPIDS MN
55433-2630
US

V. Phone/Fax

Practice location:
  • Phone: 763-421-7420
  • Fax:
Mailing address:
  • Phone: 763-421-7420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14887
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3411
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: