Provider Demographics
NPI:1417952375
Name:YOUNGER, STEPHANIE L (OD)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:L
Last Name:YOUNGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:180 N DEAN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1517
Mailing Address - Country:US
Mailing Address - Phone:864-583-3125
Mailing Address - Fax:864-542-1367
Practice Address - Street 1:363 E GEORGIA ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-1913
Practice Address - Country:US
Practice Address - Phone:864-476-8322
Practice Address - Fax:864-476-0752
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1066152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U97725Medicare UPIN