Provider Demographics
NPI:1700902822
Name:YOUNG, MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
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 1:12424 W DODGE RD
Mailing Address - Street 2:STE 104
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2322
Mailing Address - Country:US
Mailing Address - Phone:531-233-5680
Mailing Address - Fax:531-215-0937
Practice Address - Street 1:12424 W DODGE RD STE 104
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2322
Practice Address - Country:US
Practice Address - Phone:531-233-5680
Practice Address - Fax:531-215-0937
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE1064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist