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General NPI Number Information
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NPI Number | 1689852535
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Entity Type | Organization
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Legal Business Name | YOUNG OPTICAL
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Dates
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Enumeration Date | 02/02/2008
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 226 COLEMAN STE 103
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City | MARLIN
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State | TX
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Zip | 76661
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Country | US
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Telephone | 254-883-3051
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Fax | 254-803-3487
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Provider Business Mailing Address
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Address Line | PO BOX 80
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City | MARLIN
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State | TX
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Zip | 76661-0080
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Country | US
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Telephone | 254-883-3051
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Fax | 254-803-3484
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Authorized Official
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Title or Position | OWNER MANAGER
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Name | DOROTHY JANE YOUNG
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Credential |
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Telephone | 254-883-3051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156FX1201X
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Taxonomy Name | Optometric Assistant Technician
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License Number |
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License Number State | TX
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