Provider Demographics
NPI:1538262340
Name:YOUNG, STACEY L (OD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:9487 COBLENTZ AVE NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7692
Mailing Address - Country:US
Mailing Address - Phone:330-966-2400
Mailing Address - Fax:330-966-0114
Practice Address - Street 1:4139 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2819
Practice Address - Country:US
Practice Address - Phone:330-966-2400
Practice Address - Fax:330-966-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHOH4648152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2373864Medicaid
OHU58978Medicare UPIN
OH0791425Medicare PIN