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General NPI Number Information
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NPI Number | 1174673727
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Entity Type | Organization
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Legal Business Name | HARRIS R.YOUNG,O.D.
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 1311 W STEELE LN
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City | SANTA ROSA
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State | CA
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Zip | 95403-2956
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Country | US
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Telephone | 707-576-1961
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Fax | 707-576-1036
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Provider Business Mailing Address
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Address Line | 1311 W STEELE LN
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City | SANTA ROSA
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State | CA
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Zip | 95403-2956
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Country | US
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Telephone | 707-576-1961
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Fax | 707-576-1036
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HARRIS R YOUNG
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Credential | O.D.
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Telephone | 707-576-1961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT7395T
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License Number State | CA
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