Provider Demographics
NPI:1780672568
Name:YOUNG'S EYE CENTER, P.A.
Entity Type:Organization
Organization Name:YOUNG'S EYE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:940-683-2006
Mailing Address - Street 1:807 WOODROW WILSON RAY CIR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-2062
Mailing Address - Country:US
Mailing Address - Phone:940-683-2006
Mailing Address - Fax:940-683-4411
Practice Address - Street 1:807 WOODROW WILSON RAY CIR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2062
Practice Address - Country:US
Practice Address - Phone:940-683-2006
Practice Address - Fax:940-683-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1533085-01Medicaid
TX0034FCOtherBLUE CROSS/BLUE SHIELD
00097TMedicare ID - Type Unspecified