Individual
DR. JOSEPH KEITH YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
10 FAWNWOOD RD, SANDY HOOK, CT 06482-1400
(203) 364-1964
Mailing address
10 FAWNWOOD RD, SANDY HOOK, CT 06482-1400
(203) 364-1964
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
002528
CT
152WC0802X
Corneal and Contact Management Optometrist
002528
CT
152WP0200X
Pediatric Optometrist
002528
CT
152WS0006X
Sports Vision Optometrist
002528
CT
152WX0102X
Occupational Vision Optometrist
002528
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002528
CT OD LICENSE
CT
01
—
06-1581140
TAX ID #
—
01
—
1225224694
YOUNG EYES GROUP NPI
—
01
—
29317
CDS
CT
01
—
OPC3411
FLORIDA OD LICENSE NUMBER
FL
Enumeration date
12/28/2006
Last updated
03/10/2023
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