Active NPI
Gregory J Young, OD
- Optometrist
- Omaha, NE
National Provider Identifier
1689739005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 788
- Practice address
- 7300 Dodge St Ste 139
Omaha, NE 68114-3603 - Phone
- (402) 391-1112
- Fax
- (402) 391-8011
- NPI assigned
- Dec 26, 2006
- 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 | 788 | NE | Primary |
Addresses
Primary practice location
7300 Dodge St Ste 139
Omaha, NE 68114-3603
Mailing address
11103 West Ave
Suite 6
San Antonio, TX 78213-1370
Phone (210) 524-6663
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 |
|---|---|---|---|
| 788 | NE | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eyecare Centers of America | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301011200000",
"number": "1689739005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11103 WEST AVE",
"address_2": "SUITE 6",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782131370",
"telephone_number": "210-524-6663",
"fax_number": "210-524-6587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7300 DODGE ST STE 139",
"city": "OMAHA",
"state": "NE",
"postal_code": "681143603",
"telephone_number": "402-391-1112",
"fax_number": "402-391-8011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "GREGORY",
"middle_name": "J",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-26",
"last_updated": "2011-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NE",
"license": "788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.