Provider Demographics
NPI:1366438970
Name:YOUNG, JAMES MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
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 1:15555 E 14TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1978
Mailing Address - Country:US
Mailing Address - Phone:510-276-2692
Mailing Address - Fax:510-278-8859
Practice Address - Street 1:15555 E 14TH ST STE 400
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1978
Practice Address - Country:US
Practice Address - Phone:510-276-2692
Practice Address - Fax:510-278-8859
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10453152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U63157Medicare UPIN