Provider Demographics
NPI:1891819413
Name:YOUNG, SPENCER M (OD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:M
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 1:3080 NORTHWEST AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1607
Mailing Address - Country:US
Mailing Address - Phone:360-526-0075
Mailing Address - Fax:360-733-9150
Practice Address - Street 1:3080 NORTHWEST AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1607
Practice Address - Country:US
Practice Address - Phone:360-526-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8866922Medicare UPIN