Provider Demographics
NPI:1225224694
Name:YOUNG EYES, LLC
Entity type:Organization
Organization Name:YOUNG EYES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-733-7877
Mailing Address - Street 1:10 FAWNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1400
Mailing Address - Country:US
Mailing Address - Phone:203-733-7877
Mailing Address - Fax:
Practice Address - Street 1:25 CHURCH HILL RD UNIT 205
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1639
Practice Address - Country:US
Practice Address - Phone:203-733-7877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002528152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT29317OtherCT THERAPEUTIC
CT002528OtherCT OD LICENSE
CT002528OtherCT OD LICENSE
CT4045590001Medicare NSC
C02619Medicare PIN
U79847Medicare UPIN