Active NPI
Lawrence Edwin Young, O. D.
- Optometrist
- Fontana, CA
National Provider Identifier
1285858936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 8618T
- Practice address
- 10004 Sierra Ave
Fontana, CA 92335-6723 - Phone
- (909) 822-6941
- Fax
- (909) 822-3985
- NPI assigned
- Apr 12, 2007
- Last updated
- Jul 24, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 8618T | CA | Primary |
Addresses
Primary practice location
10004 Sierra Ave
Fontana, CA 92335-6723
Mailing address
10004 Sierra Ave
Fontana, CA 92335-6723
Phone (909) 822-6941
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0086180 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8618 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| 8618T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248393600000",
"number": "1285858936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10004 SIERRA AVE",
"city": "FONTANA",
"state": "CA",
"postal_code": "923356723",
"telephone_number": "909-822-6941",
"fax_number": "909-822-3985"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10004 SIERRA AVE",
"city": "FONTANA",
"state": "CA",
"postal_code": "923356723",
"telephone_number": "909-822-6941",
"fax_number": "909-822-3985"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "LAWRENCE",
"middle_name": "EDWIN",
"name_prefix": "Dr.",
"credential": "O. D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-12",
"last_updated": "2009-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "8618T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0086180",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fontana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2009; 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.