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General NPI Number Information
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NPI Number | 1649709015
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Entity Type | Individual
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Provider Name | ADRIA YOUNG OD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 801 CR 466 SUITE 102 SUNSET PLAZA
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City | LADY LAKE
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State | FL
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Zip | 32159
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Country | US
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Telephone | 352-350-2070
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Fax |
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Provider Business Mailing Address
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Address Line | 6740 NW 15TH AVE
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City | OCALA
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State | FL
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Zip | 34475-8557
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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 |
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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 | OPC5469
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License Number State | FL
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