Provider Demographics
NPI:1225341704
Name:MICHAEL J YOUNG
Entity Type:Organization
Organization Name:MICHAEL J YOUNG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-922-1993
Mailing Address - Street 1:327 E PLAZA DR STE 1B
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6930
Mailing Address - Country:US
Mailing Address - Phone:805-922-1993
Mailing Address - Fax:805-933-1994
Practice Address - Street 1:327 EAST PLAZA DRIVE #1B
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6930
Practice Address - Country:US
Practice Address - Phone:805-922-1993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL J YOUNG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10256152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1160850001Medicare NSC