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General NPI Number Information
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NPI Number | 1184389751
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Entity Type | Organization
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Legal Business Name | YOUNG OPTOMETRIC CORPORATION, PC
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 1300 DANA DR
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City | REDDING
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State | CA
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Zip | 96003-4071
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Country | US
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Telephone | 630-722-3533
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Fax |
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Provider Business Mailing Address
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Address Line | 1979 MARCUS AVE STE 206
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER OF OPEN DOCTOR PANEL
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Name | LAURA BASILE
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Credential |
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Telephone | 516-243-8708
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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 |
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License Number State |
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