Provider Demographics
NPI:1437406881
Name:YOUNG, CASSANDRA RUTH (OD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:RUTH
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:RUTH
Other - Last Name:DONAUDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38 FENN RD
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2212
Mailing Address - Country:US
Mailing Address - Phone:860-436-4410
Mailing Address - Fax:
Practice Address - Street 1:38 FENN RD
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111
Practice Address - Country:US
Practice Address - Phone:860-436-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-04
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY56 007897152W00000X
CT002876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist