Healthcare Provider Details

I. General information

NPI: 1811039407
Provider Name (Legal Business Name): WALLACE HOWARD YOUNG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10426 BRIARCOVE LN
CINCINNATI OH
45242-4602
US

IV. Provider business mailing address

10426 BRIARCOVE LN
CINCINNATI OH
45242-4602
US

V. Phone/Fax

Practice location:
  • Phone: 513-793-5150
  • Fax:
Mailing address:
  • Phone: 513-793-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3053
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3053
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number3053
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: