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General NPI Number Information
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NPI Number | 1962545194
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Entity Type | Individual
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Provider Name | BEVERLY YOUNG O.D.
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Gender | Female
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 1138 NEWPARK MALL
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City | NEWARK
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State | CA
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Zip | 94560-5246
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Country | US
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Telephone | 510-790-1001
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Fax | 510-790-1704
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Provider Business Mailing Address
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Address Line | 201 E GRANT LINE RD #14
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City | TRACY
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State | CA
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Zip | 95376-2763
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Country | US
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Telephone | 209-832-7839
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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 | 9185
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License Number State | CA
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