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General NPI Number Information
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NPI Number | 1376660340
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Entity Type | Organization
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Legal Business Name | ELWOOD M YOUNG OD PC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | 406 1ST ST
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City | GLENWOOD
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State | IA
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Zip | 51534-1706
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Country | US
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Telephone | 712-527-4468
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Fax | 712-527-9458
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Provider Business Mailing Address
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Address Line | 406 1ST ST PO BOX 188
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City | GLENWOOD
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State | IA
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Zip | 51534-1706
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Country | US
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Telephone | 712-527-4468
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Fax | 712-527-9458
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACQUE DIANE YOUNG
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Credential | OD
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Telephone | 712-527-4468
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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 | 01809
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License Number State | IA
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