Provider Demographics
NPI:1508954652
Name:YOUNES, MICHAEL GEORGE (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:YOUNES
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 1:7565 CRESCENDO LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3841
Mailing Address - Country:US
Mailing Address - Phone:313-485-1044
Mailing Address - Fax:
Practice Address - Street 1:525 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4007
Practice Address - Country:US
Practice Address - Phone:619-515-2498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004250152W00000X
CA14874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI944933475Medicaid
MIV02043Medicare UPIN