=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376547075
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANK C YOUNG III M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2005
-----------------------------------------------------
Last Update Date | 05/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 NORMANDIE DR
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36111-2712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-286-2020
-----------------------------------------------------
Fax | 334-286-2029
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2020 NORMANDIE DR
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36111-2712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-286-2020
-----------------------------------------------------
Fax | 334-286-2029
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 41492
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------