Provider Demographics
NPI:1154498723
Name:YOUNG, STEVEN R (BCO BOARD CERTIFIED)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:M
Credentials:BCO BOARD CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 30TH STREET
Mailing Address - Street 2:STE 512
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3303
Mailing Address - Country:US
Mailing Address - Phone:510-836-2123
Mailing Address - Fax:510-836-0383
Practice Address - Street 1:411 30TH STREET
Practice Address - Street 2:STE 512
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3303
Practice Address - Country:US
Practice Address - Phone:510-836-2123
Practice Address - Fax:510-836-0383
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ76594ZMedicaid
CAZZZ76594ZMedicaid
ZZZ76594ZMedicare PIN