Provider Demographics
NPI:1063458727
Name:YOUNG, MICHAEL J (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:YOUNG
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:J
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTOMETRIST
Mailing Address - Street 1:910 E STOWELL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7001
Mailing Address - Country:US
Mailing Address - Phone:805-925-2637
Mailing Address - Fax:805-925-9013
Practice Address - Street 1:4850 S BRADLEY RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5071
Practice Address - Country:US
Practice Address - Phone:805-937-9532
Practice Address - Fax:805-937-6009
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10256156FX1900X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No156FX1900XEye and Vision Services ProvidersTechnician/TechnologistOrthoptist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU63025Medicare UPIN
CAOP10256Medicare ID - Type Unspecified