Healthcare Provider Details

I. General information

NPI: 1457732562
Provider Name (Legal Business Name): CARLEE YOUNG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 03/07/2023
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 LEGACY DR STE 500
FRISCO TX
75034-8340
US

IV. Provider business mailing address

2575 YORBA LINDA BLVD
FULLERTON CA
92831-1615
US

V. Phone/Fax

Practice location:
  • Phone: 214-619-5580
  • Fax:
Mailing address:
  • Phone: 714-449-7401
  • Fax: 714-992-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT15276
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPT15276
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8650TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: