Healthcare Provider Details

I. General information

NPI: 1780672568
Provider Name (Legal Business Name): YOUNG'S EYE CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 WOODROW WILSON RAY CIR
BRIDGEPORT TX
76426-2062
US

IV. Provider business mailing address

807 WOODROW WILSON RAY CIR
BRIDGEPORT TX
76426-2062
US

V. Phone/Fax

Practice location:
  • Phone: 940-683-2006
  • Fax: 940-683-4411
Mailing address:
  • Phone: 940-683-2006
  • Fax: 940-683-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICIA R. YOUNG
Title or Position: VICE PRESIDENT
Credential: O.D.
Phone: 940-683-2006