Active NPI
Thomas A Young, O.D.
- Optometrist
- Mitchell, SD
National Provider Identifier
1417964792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 451
- Practice address
- 211 E Havens St
Mitchell, SD 57301-4402 - Phone
- (605) 996-4671
- Fax
- (605) 996-4671
- NPI assigned
- Aug 1, 2006
- Last updated
- Oct 18, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 | 451 | SD | Primary |
Addresses
Primary practice location
211 E Havens St
Mitchell, SD 57301-4402
Mailing address
211 E Havens St
Mitchell, SD 57301-4402
Phone (605) 996-4671
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00849313 | Other | SD | RAILROAD MEDICARE |
| 0076548 | Other | SD | BLUE CROSS BLUE SHIELD |
| 4266 | Other | SD | AVERA HEALTH PLANS |
| 9201890 | Medicaid | SD | |
| 0530030001 | Other | SD | DMERC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 451 | SD | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287360000000",
"number": "1417964792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 E HAVENS ST",
"city": "MITCHELL",
"state": "SD",
"postal_code": "573014402",
"telephone_number": "605-996-4671",
"fax_number": "605-996-4671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 E HAVENS ST",
"city": "MITCHELL",
"state": "SD",
"postal_code": "573014402",
"telephone_number": "605-996-4671",
"fax_number": "605-996-4671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "THOMAS",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2010-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "SD",
"license": "451",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00849313",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0076548",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVERA HEALTH PLANS",
"identifier": "4266",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9201890",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC",
"identifier": "0530030001",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mitchell, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.