Provider Demographics
NPI:1851507552
Name:YOUNG EYE ASSOCIATES OD PA
Entity Type:Organization
Organization Name:YOUNG EYE ASSOCIATES OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-494-9321
Mailing Address - Street 1:10676 NW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2542
Mailing Address - Country:US
Mailing Address - Phone:305-494-9321
Mailing Address - Fax:305-403-6967
Practice Address - Street 1:1869 NW 20TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-7431
Practice Address - Country:US
Practice Address - Phone:305-494-9321
Practice Address - Fax:305-403-6967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3765152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8329Medicare ID - Type UnspecifiedGROUP NUMBER