Healthcare Provider Details

I. General information

NPI: 1770883449
Provider Name (Legal Business Name): JEFFREY OGDEN YOUNG OPTHALMIC DISPENSER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 SHONNARD AVE
FREEPORT NY
11520-2440
US

IV. Provider business mailing address

73 SHONNARD AVE
FREEPORT NY
11520-2440
US

V. Phone/Fax

Practice location:
  • Phone: 516-643-5794
  • Fax:
Mailing address:
  • Phone: 516-643-5794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number006221-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: