Healthcare Provider Details

I. General information

NPI: 1689852535
Provider Name (Legal Business Name): YOUNG OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2008
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 COLEMAN STE 103
MARLIN TX
76661
US

IV. Provider business mailing address

PO BOX 80
MARLIN TX
76661-0080
US

V. Phone/Fax

Practice location:
  • Phone: 254-883-3051
  • Fax: 254-803-3487
Mailing address:
  • Phone: 254-883-3051
  • Fax: 254-803-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1201X
TaxonomyOptometric Assistant Technician
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY JANE YOUNG
Title or Position: OWNER MANAGER
Credential:
Phone: 254-883-3051