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General NPI Number Information
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NPI Number | 1225341704
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Entity Type | Organization
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Legal Business Name | MICHAEL J YOUNG
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 327 EAST PLAZA DRIVE #1B
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City | SANTA MARIA
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State | CA
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Zip | 93454-6930
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Country | US
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Telephone | 805-922-1993
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Fax |
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Provider Business Mailing Address
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Address Line | 327 E PLAZA DR STE 1B
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City | SANTA MARIA
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State | CA
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Zip | 93454-6930
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Country | US
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Telephone | 805-922-1993
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Fax | 805-933-1994
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL J YOUNG
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Credential | OD
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Telephone | 805-922-1993
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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 | 10256
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License Number State | CA
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