Provider Demographics
NPI:1346423639
Name:STEVEN R. YOUNG, OCULARIST, INC.
Entity Type:Organization
Organization Name:STEVEN R. YOUNG, OCULARIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCULARIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:510-836-2123
Mailing Address - Street 1:411 30TH ST
Mailing Address - Street 2:SUITE 512
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3301
Mailing Address - Country:US
Mailing Address - Phone:510-836-2123
Mailing Address - Fax:510-836-0383
Practice Address - Street 1:411 30TH ST
Practice Address - Street 2:SUITE 512
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3301
Practice Address - Country:US
Practice Address - Phone:510-836-2123
Practice Address - Fax:510-836-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ76594ZMedicaid
CAZZZ76594ZMedicaid
0264940001Medicare NSC