Provider Demographics
NPI:1083657639
Name:YOUNG, LAURA LEE PERLAKY (OD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE PERLAKY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6044 W HIGHWAY 74
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-3591
Mailing Address - Country:US
Mailing Address - Phone:704-821-3937
Mailing Address - Fax:704-821-3938
Practice Address - Street 1:6044 W HIGHWAY 74
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-3591
Practice Address - Country:US
Practice Address - Phone:704-821-3937
Practice Address - Fax:704-821-3938
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5580152W00000X
NC2021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2725364OtherUNITED HEALTHCARE
NC5914143Medicaid
NC093VWOtherBCBS
NC2725364OtherUNITED HEALTHCARE
NC5914143Medicaid
NC093VWOtherBCBS
NC2474313DMedicare PIN