Provider Demographics
NPI:1619043601
Name:YOUNG, RICHARD E (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
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 1:89 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1742
Mailing Address - Country:US
Mailing Address - Phone:631-757-6190
Mailing Address - Fax:631-757-4759
Practice Address - Street 1:89 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1742
Practice Address - Country:US
Practice Address - Phone:631-757-6190
Practice Address - Fax:631-757-4759
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004955-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4587790001Medicare NSC