MEDICARE: BECKY YEUNG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	14887	CA
2	152W00000X	Optometrist	3411	MN

General Provider Information

NPI Number	:	1568873123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKY YEUNG O.D.

Provider Business Mailing Address
First Line	:	3777 COON RAPIDS BLVD NW
Second Line	:	SUITE 100
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-2630
Country	:	US
Telephone Number	:	763-421-7420
Fax Number	:

Provider Business Practice Location Address
First Line	:	3777 COON RAPIDS BLVD NW
Second Line	:	SUITE 100
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-2630
Country	:	US
Telephone Number	:	763-421-7420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2014
Last Update Date	:	10/02/2014

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