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General NPI Number Information
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NPI Number | 1114025111
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Entity Type | Organization
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Legal Business Name | YOUNG EYE INSTITUTE
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 4214 SW LEE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-8340
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Country | US
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Telephone | 580-353-5860
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Fax | 580-353-0792
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Provider Business Mailing Address
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Address Line | 4214 SW LEE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-8340
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Country | US
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Telephone | 580-353-5860
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Fax | 580-353-0792
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOSEPH J YOUNG
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Credential | M.D.
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Telephone | 580-353-5860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 13033
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License Number State | OK
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