Stephenie L Young, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046010569 Issued in IL

Practice address

3123 N Broadway St Ste a
Chicago, IL 60657-4522

Phone

(773) 880-5400

Fax

(773) 880-5406

NPI assigned

Jun 29, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1346504891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "942 N HOYNE AVE APT 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606224903",
            "telephone_number": "517-230-5871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3123 N BROADWAY ST STE A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606574522",
            "telephone_number": "773-880-5400",
            "fax_number": "773-880-5406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "STEPHENIE",
        "middle_name": "L",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-29",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "IL",
            "license": "046010569",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046010569",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "502720057",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shahtavia Young, LSW
• Simone Young, PSYD
• Sondra Shemece Young
• Starlynda Young, O.T.
• Stephen C Young
• Unique Young
• William Young
• Zetah Young, LCPC
• Jeffre Katherine Youngblood, COTA/L
• Mark Youngblood, MD, PHD

• Optometrist in Chicago, IL
• Providers in Chicago, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.