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General NPI Number Information
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NPI Number | 1376519397
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Entity Type | Individual
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Provider Name | VINCENT MICHAEL YOUNG D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 08/18/2010
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Provider Practice Location Address
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Address Line | 112 S. MAIN
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City | BLANCHARD
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State | OK
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Zip | 73010
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Country | US
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Telephone | 405-485-3937
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Fax | 405-485-3642
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Provider Business Mailing Address
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Address Line | PO BOX 325
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City | BLANCHARD
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State | OK
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Zip | 73010-0325
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Country | US
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Telephone | 405-485-3937
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Fax | 405-485-3642
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2441
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License Number State | OK
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