Provider Demographics
NPI:1467575373
Name:YOUNG, DAWN PATRICIA (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:PATRICIA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4391 SOUTH ST. EXT.
Mailing Address - Street 2:
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886
Mailing Address - Country:US
Mailing Address - Phone:607-387-6098
Mailing Address - Fax:607-272-7776
Practice Address - Street 1:609 W CLINTON ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5255
Practice Address - Country:US
Practice Address - Phone:607-272-7775
Practice Address - Fax:607-272-7776
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5536217156FC0800X, 156FC0801X
NYC006861-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
Not Answered156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician