NPIMap

Organization Active NPI

Michael O Young OD PC

  • Optometrist
  • Fort Wayne, IN
National Provider Identifier
1487724258
Registry record updated Nov 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18002134A Issued in IN
Legal business name
MICHAEL O YOUNG OD PC
Practice address
6424 W Jefferson Blvd
Suite a
Fort Wayne, IN 46804-6204
Phone
(260) 969-1400
Fax
(260) 969-0322
NPI assigned
Nov 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2012

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

Authorized official

Name
Michael Owen Young, ODNPI 1043380819
Title
President
Phone
(260) 969-1400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 18002134A IN Primary

Addresses

Primary practice location

6424 W Jefferson Blvd
Suite a
Fort Wayne, IN 46804-6204

Mailing address

6424 W Jefferson Blvd
Suite a
Fort Wayne, IN 46804-6204
Phone (260) 969-1400

Other identifiers 3

IdentifierTypeStateIssuer
18808OtherSPECTERA
IN2134OtherEYEMED
100080510AMedicaidIN

National Provider Directory

National Provider Directory

Locations

6424 W Jefferson Blvd
Ste A
Fort Wayne, IN 46804
Phone (219) 424-7176

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1487724258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6424 W JEFFERSON BLVD",
            "address_2": "SUITE A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046204",
            "telephone_number": "260-969-1400",
            "fax_number": "260-969-0322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6424 W JEFFERSON BLVD",
            "address_2": "SUITE A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046204",
            "telephone_number": "260-969-1400",
            "fax_number": "260-969-0322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL O YOUNG OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "OWEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-969-1400",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002134A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "18808",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "IN2134",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100080510A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; 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.