Provider Demographics
NPI:1457348385
Name:YOUNG, PATRICIA R (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:807 WOODROW WILSON RAY CIR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-2062
Mailing Address - Country:US
Mailing Address - Phone:940-683-2006
Mailing Address - Fax:940-683-4411
Practice Address - Street 1:807 WOODROW WILSON RAY CIR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2062
Practice Address - Country:US
Practice Address - Phone:940-683-2006
Practice Address - Fax:940-683-4411
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5045TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U52233Medicare UPIN
P00111133Medicare PIN
00097TMedicare PIN
5186720001Medicare NSC