Provider Demographics
NPI:1952401978
Name:YOUNG, HEIDI L (OD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHLAND AVE.
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-728-1400
Mailing Address - Fax:401-270-9623
Practice Address - Street 1:100 HIGHLAND AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-728-1400
Practice Address - Fax:401-270-9623
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00496152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9007970Medicaid
RI419026334Medicare UPIN
U38206Medicare UPIN
RI419026334Medicare ID - Type Unspecified
RI9007970Medicaid