Individual
JACQUE DIANE YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
406 1ST ST, GLENWOOD, IA 51534-1706
(712) 527-4468
(712) 527-9458
Mailing address
PO BOX 188, 406 1ST STREET, GLENWOOD, IA 51534-0188
(712) 527-4468
(712) 527-9458
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1809
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0038547
—
IA
01
—
410015491
RAILROAD MEDICARE
IA
Enumeration date
01/19/2006
Last updated
09/28/2011
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