Healthcare Provider Details

I. General information

NPI: 1750842894
Provider Name (Legal Business Name): LAUREN MICHELLE YOUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MICHELLE EHLE MD

II. Dates (important events)

Enumeration Date: 03/30/2019
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11013 HEFNER POINTE DR
OKLAHOMA CITY OK
73120-5035
US

IV. Provider business mailing address

11013 HEFNER POINTE DR
OKLAHOMA CITY OK
73120-5035
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-2020
  • Fax: 405-751-3838
Mailing address:
  • Phone: 405-751-2020
  • Fax: 405-751-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number43328
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberBP20073166
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number57978
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number43328
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: