Provider Demographics
NPI:1447773452
Name:YOUNG, ANDREW STEVEN (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:STEVEN
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 1:1430 N VINITA AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-6434
Mailing Address - Country:US
Mailing Address - Phone:918-822-1895
Mailing Address - Fax:
Practice Address - Street 1:859 E MELTON DR
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-2704
Practice Address - Country:US
Practice Address - Phone:918-253-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2959152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist