Organization
YOUNG EYE CLINIC LLC
Active
Other names
Young Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY PATRICK YOUNG OD (DOCTOR / OWNER)
(405) 728-3393
Entity
Organization
Contact information
Practice address
12325 N ROCKWELL AVE, OKLAHOMA CITY, OK 73142-2702
(405) 728-3393
Mailing address
12325 N ROCKWELL AVE, OKLAHOMA CITY, OK 73142-2702
(405) 728-3393
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2117
OK
152WC0802X
Corneal and Contact Management Optometrist
2117
OK
152WS0006X
Sports Vision Optometrist
2117
OK
152WX0102X
Occupational Vision Optometrist
2117
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100760340A
—
OK
01
—
4057283393
VISION SERVICE PLAN
CA
01
—
918288
EYEMED
—
Enumeration date
12/06/2017
Last updated
06/16/2018
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