Provider Demographics
NPI:1952389520
Name:YOUNG, MASON L (OD)
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:L
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 1:400 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-2724
Mailing Address - Country:US
Mailing Address - Phone:870-857-2020
Mailing Address - Fax:870-857-2022
Practice Address - Street 1:400 W 4TH ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-2724
Practice Address - Country:US
Practice Address - Phone:870-857-2020
Practice Address - Fax:870-857-2022
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2536152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150870722Medicaid
AR49866OtherBLUE CROSS / BLUE SHIELD
49866Medicare PIN
AR150870722Medicaid
U97211Medicare UPIN