Provider Demographics
NPI:1003988197
Name:YOUNG, WAYNE MATTHEW (OPTOMETRY)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:MATTHEW
Last Name:YOUNG
Suffix:
Gender:M
Credentials:OPTOMETRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1852
Mailing Address - Country:US
Mailing Address - Phone:614-779-6724
Mailing Address - Fax:740-779-6727
Practice Address - Street 1:1270 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1852
Practice Address - Country:US
Practice Address - Phone:614-779-6724
Practice Address - Fax:740-779-6727
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1625152W00000X
OH5593 T2507152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist