Provider Demographics
NPI:1710968698
Name:YOUNG, LAURA MAE (OD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MAE
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 1:1401 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1367
Mailing Address - Country:US
Mailing Address - Phone:209-527-6640
Mailing Address - Fax:209-527-5489
Practice Address - Street 1:1401 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1367
Practice Address - Country:US
Practice Address - Phone:209-527-6640
Practice Address - Fax:209-527-5489
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6585TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16478OtherMEDICAL EYE SERVICES
CA16478OtherMEDICAL EYE SERVICES
U37333Medicare UPIN