Individual
STEPHENIE L YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
3123 N BROADWAY ST STE A, CHICAGO, IL 60657-4522
(773) 880-5400
(773) 880-5406
Mailing address
942 N HOYNE AVE APT 2, CHICAGO, IL 60622-4903
(517) 230-5871
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010569
IL
152WC0802X
Corneal and Contact Management Optometrist
046010569
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046010569
—
IL
01
—
502720057
MEDICARE PTAN
IL
Enumeration date
06/29/2012
Last updated
11/17/2020
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