Provider Demographics
NPI:1457732562
Name:YOUNG, CARLEE (OD)
Entity type:Individual
Prefix:
First Name:CARLEE
Middle Name:
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 1:2575 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1615
Mailing Address - Country:US
Mailing Address - Phone:714-449-7401
Mailing Address - Fax:714-992-7850
Practice Address - Street 1:3140 LEGACY DR STE 500
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8340
Practice Address - Country:US
Practice Address - Phone:214-619-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT15276152W00000X, 152WP0200X
TX8650TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1234530001OtherDMERC
TX1457732562OtherNPI
TX8650TGOtherSTATE LICENSE
TX1902852346OtherGROUP NPI
TX752711435OtherGROUP TAX ID
TX00E41YOtherGROUP PIN
TX85336QOtherBCBS
TX10228305OtherDPS
TX10228305OtherDPS
TXMY3912361OtherDEA
TX500262YSFPMedicare PIN