Provider Demographics
NPI:1194841957
Name:YOUNG & ASSOCIATES , INC
Entity Type:Organization
Organization Name:YOUNG & ASSOCIATES , INC
Other - Org Name:PROFESSIONAL EYECARE CROSSROADS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-393-5876
Mailing Address - Street 1:7356 DODGE ST
Mailing Address - Street 2:STE 230
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114
Mailing Address - Country:US
Mailing Address - Phone:402-393-5876
Mailing Address - Fax:402-393-7684
Practice Address - Street 1:7356 DODGE ST
Practice Address - Street 2:STE. 230
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-393-5876
Practice Address - Fax:402-393-7684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE1064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEU56740Medicare UPIN