Provider Demographics
NPI:1003336645
Name:YOUNG, BENJAMIN (OD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4199 WASHINGTON ST # 2
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1733
Mailing Address - Country:US
Mailing Address - Phone:617-323-7300
Mailing Address - Fax:
Practice Address - Street 1:4199 WASHINGTON ST # 2
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-1733
Practice Address - Country:US
Practice Address - Phone:617-323-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-25
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5282152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist