MEDICARE: GRACE YOUNG 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	3051	OK

General Provider Information

NPI Number	:	1629491899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE YOUNG O.D.

Provider Business Mailing Address
First Line	:	6130 S MAPLEWOOD AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-2134
Country	:	US
Telephone Number	:	918-492-0849
Fax Number	:	918-492-3190

Provider Business Practice Location Address
First Line	:	6130 S MAPLEWOOD AVE STE D
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-2128
Country	:	US
Telephone Number	:	918-492-0849
Fax Number	:	918-492-3190

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

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/05/2026

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