Provider Demographics
NPI:1336389626
Name:YOUNG, MELTONIA LORETTA (TDO)
Entity Type:Individual
Prefix:MS
First Name:MELTONIA
Middle Name:LORETTA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:TDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 PARKVIEW TER
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-9514
Mailing Address - Country:US
Mailing Address - Phone:336-653-4494
Mailing Address - Fax:
Practice Address - Street 1:116 GREENSBORO RD
Practice Address - Street 2:103
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-3454
Practice Address - Country:US
Practice Address - Phone:336-653-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1539156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician