Provider Demographics
NPI:1376660340
Name:ELWOOD M YOUNG OD PC
Entity Type:Organization
Organization Name:ELWOOD M YOUNG OD PC
Other - Org Name:YOUNG VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-527-4468
Mailing Address - Street 1:406 1ST ST
Mailing Address - Street 2:PO BOX 188
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-1706
Mailing Address - Country:US
Mailing Address - Phone:712-527-4468
Mailing Address - Fax:712-527-9458
Practice Address - Street 1:406 1ST ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1706
Practice Address - Country:US
Practice Address - Phone:712-527-4468
Practice Address - Fax:712-527-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0038547Medicaid
IA410015491OtherRAILROAD MEDICARE
IA24626Medicare PIN
IA0038547Medicaid
IA1073580001Medicare NSC