NPIMap

Organization Active NPI

Stacey Young OD Inc

Doing business as Eyecare Specialties

  • Optometrist
  • Canton, OH
National Provider Identifier
1558807826
Registry record updated Jan 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4648 Issued in OH
Legal business name
STACEY YOUNG OD INC
Doing business as
Eyecare Specialties
Practice address
4139 Fulton Dr NW
Canton, OH 44718-2819
Phone
(330) 966-2400
NPI assigned
Jan 11, 2017
Last updated
Jan 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2017

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

Authorized official

Name
Stacey Young, ODNPI 1538262340
Title
Owner
Phone
(330) 966-2400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 4648 OH Primary

Addresses

Primary practice location

4139 Fulton Dr NW
Canton, OH 44718-2819

Mailing address

4139 Fulton Dr NW
Canton, OH 44718-2819
Phone (330) 966-2400

Other identifiers 1

IdentifierTypeStateIssuer
2373864MedicaidOH

Other names 1

  • Eyecare Specialties Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1484092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484092800000",
    "number": "1558807826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4139 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182819",
            "telephone_number": "330-966-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4139 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182819",
            "telephone_number": "330-966-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACEY YOUNG OD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-11",
        "last_updated": "2017-01-11",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-966-2400",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OH",
            "license": "4648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2373864",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyecare Specialties",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; 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.