Individual
MICHAEL OWEN YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
6424 W JEFFERSON BLVD, SUITE A, FORT WAYNE, IN 46804-6204
(260) 436-7530
(260) 436-2698
Mailing address
6424 W JEFFERSON BLVD, SUITE A, FORT WAYNE, IN 46804-6204
(260) 436-7530
(260) 436-2698
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002134A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18808
SPECTERA
—
01
—
IN2134
EYEMED
—
Enumeration date
11/09/2006
Last updated
11/27/2007
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