Provider Demographics
NPI:1912009234
Name:VINCENT MICHAEL YOUNG OD PC
Entity Type:Organization
Organization Name:VINCENT MICHAEL YOUNG OD PC
Other - Org Name:BLANCHARD EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-485-3937
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-0325
Mailing Address - Country:US
Mailing Address - Phone:405-485-3937
Mailing Address - Fax:
Practice Address - Street 1:112 S. MAIN
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-8003
Practice Address - Country:US
Practice Address - Phone:405-485-3937
Practice Address - Fax:405-485-3642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2441152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5656891OtherFIRST HEALTH PROVIDER #
OK200066400AMedicaid
OK2569827OtherUNITEDHEALTHCARE PROV#
OKOK2441OtherEYEMED
OK245720OtherCOMPBENEFITS
OKOK02441OtherVISION BENEFITS ACCT #
OK7530792OtherAETNA PROVIDER NUMBER
OK200066400AMedicaid
OKOK02441OtherVISION BENEFITS ACCT #
OK500522126Medicare PIN
245533902Medicare PIN