Provider Demographics
NPI:1376519397
Name:YOUNG, VINCENT MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:MICHAEL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-0325
Mailing Address - Country:US
Mailing Address - Phone:405-485-3937
Mailing Address - Fax:405-485-3642
Practice Address - Street 1:112 S. MAIN
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010
Practice Address - Country:US
Practice Address - Phone:405-485-3937
Practice Address - Fax:405-485-3642
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2441152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK2441OtherEYEMED
OK200053840AMedicaid
OK200053840AMedicaid
OK500522126Medicare ID - Type Unspecified
$$$$$$$$$001OtherBCBS IDENTIFIER
OK200053840AMedicaid