Provider Demographics
NPI:1194919985
Name:YOUNG, KAREN D (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:D
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11279 S GLENWOOD AVE # 11075
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-6825
Mailing Address - Country:US
Mailing Address - Phone:928-257-8687
Mailing Address - Fax:
Practice Address - Street 1:1462 S PACIFIC AVE
Practice Address - Street 2:3150 S 4TH AVE
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-1733
Practice Address - Country:US
Practice Address - Phone:928-783-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ546152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU51868Medicare UPIN