Provider Demographics
NPI:1568497378
Name:YOUNG, MINDY S (OD)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:S
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9656 LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2139
Mailing Address - Country:US
Mailing Address - Phone:626-286-1993
Mailing Address - Fax:
Practice Address - Street 1:9656 LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-2139
Practice Address - Country:US
Practice Address - Phone:626-286-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT10609T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0106090Medicaid
CAOP0609Medicare PIN