Provider Demographics
NPI:1093700114
Name:YOUNG, TRACY L (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:L
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 1:845 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-4878
Mailing Address - Country:US
Mailing Address - Phone:610-692-8100
Mailing Address - Fax:610-436-4011
Practice Address - Street 1:845 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4878
Practice Address - Country:US
Practice Address - Phone:610-692-8100
Practice Address - Fax:610-436-4011
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000208152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA022248EHDMedicare PIN
PAU73304Medicare UPIN