Provider Demographics
NPI:1265745285
Name:YOUNG, LEA U (OD)
Entity type:Individual
Prefix:DR
First Name:LEA
Middle Name:U
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 1:511 MANAWAI ST APT 401
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2072
Mailing Address - Country:US
Mailing Address - Phone:808-674-2273
Mailing Address - Fax:
Practice Address - Street 1:511 MANAWAI ST APT 401
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2072
Practice Address - Country:US
Practice Address - Phone:808-674-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist