Provider Demographics
NPI:1245348598
Name:JOSEPH J YOUNG
Entity type:Organization
Organization Name:JOSEPH J YOUNG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-353-5860
Mailing Address - Street 1:4214 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8340
Mailing Address - Country:US
Mailing Address - Phone:580-353-5860
Mailing Address - Fax:580-353-0792
Practice Address - Street 1:4214 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8340
Practice Address - Country:US
Practice Address - Phone:580-353-5860
Practice Address - Fax:580-353-0792
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUNG EYE INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-28
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100808390AMedicaid
OK0594260001Medicare NSC