Jacque Diane Young, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1809 Issued in IA

Practice address

406 1St St
Glenwood, IA 51534-1706

Phone

(712) 527-4468

Fax

(712) 527-9458

NPI assigned

Jan 19, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gle Glenwood LLC

  dba Young Vision Care

  • Optometrist
  • Glenwood, IA
  • NPI 1821709957
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317168000000",
    "number": "1174503734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "address_2": "406 1ST STREET",
            "city": "GLENWOOD",
            "state": "IA",
            "postal_code": "515340188",
            "telephone_number": "712-527-4468",
            "fax_number": "712-527-9458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 1ST ST",
            "city": "GLENWOOD",
            "state": "IA",
            "postal_code": "515341706",
            "telephone_number": "712-527-4468",
            "fax_number": "712-527-9458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "JACQUE",
        "middle_name": "DIANE",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-19",
        "last_updated": "2011-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "1809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410015491",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0038547",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ariana Wilson
• Charley Wilson, APRN
• Carol Wright, PHARMD
• Savana Yager, LISW
• Young Vision Care
• Jennifer Lee Young, PT

• Optometrist in Glenwood, IA
• Providers in Glenwood, IA by specialty
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.