Provider Demographics
NPI:1700837887
Name:YOUNG, MICHAEL RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:YOUNG
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:841 HARTNELL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2151
Mailing Address - Country:US
Mailing Address - Phone:530-222-1233
Mailing Address - Fax:530-222-4300
Practice Address - Street 1:841 HARTNELL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2151
Practice Address - Country:US
Practice Address - Phone:530-222-1233
Practice Address - Fax:530-222-4300
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2008-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA09131T152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA410027235OtherRAIL ROAD MEDICARE
CA680230976OtherVISION SERVICE PLAN
CA680230976OtherOTHER MEDICAL INSURANCE
CA680230976OtherBLUESHIELD / BLUECROSS
CASD0091310Medicaid
CA410027235OtherRAIL ROAD MEDICARE
CASD0091310Medicaid
CA680230976OtherVISION SERVICE PLAN