Provider Demographics
NPI:1649336355
Name:YOUNG, JOSEPH KEITH (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KEITH
Last Name:YOUNG
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 1:10 FAWNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1400
Mailing Address - Country:US
Mailing Address - Phone:203-364-1964
Mailing Address - Fax:
Practice Address - Street 1:10 FAWNWOOD RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1400
Practice Address - Country:US
Practice Address - Phone:203-364-1964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002528152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002528OtherCT OD LICENSE
CT29317OtherCDS
FLOPC3411OtherFLORIDA OD LICENSE NUMBER
06-1581140OtherTAX ID #
1225224694OtherYOUNG EYES GROUP NPI
FLOPC3411OtherFLORIDA OD LICENSE NUMBER
1225224694OtherYOUNG EYES GROUP NPI
MY05004490OtherDEA