Provider Demographics
NPI:1235192337
Name:YOUNG, ARTHUR T (OD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:T
Last Name:YOUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9310
Mailing Address - Country:US
Mailing Address - Phone:239-939-3456
Mailing Address - Fax:239-936-8212
Practice Address - Street 1:4101 EVANS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9310
Practice Address - Country:US
Practice Address - Phone:239-939-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084222200Medicaid
FL19800OtherBLUE CROSS BLUE SHIELD
FL5848106OtherAETNA
FL19800XOtherMEDICARE ID UNSPECIFIED
FL4785695OtherCIGNA
FL19800XOtherMEDICARE ID UNSPECIFIED
FL4785695OtherCIGNA