Individual provider Active NPI

Melissa Marie Serreyn Younger

  • Optometrist
  • Gillette, WY
National Provider Identifier
1770818858
Registry record updated Jan 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
408T Issued in WY
Practice address
609 4J CT
Gillette, WY 82716-4135
Phone
(307) 682-2020
Fax
(307) 682-5656
NPI assigned
Oct 7, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 408T WY Primary
Optometrist 152W00000X 3270 MN

Addresses

Primary practice location

609 4J CT
Gillette, WY 82716-4135

Mailing address

609 4J CT
Gillette, WY 82716-4135
Phone (307) 682-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161122002254 WY Practitioner - Optometry 0143488643 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gillette Optometric Clinic PCGroup PAC ID 3870507221, 6 clinicians

Practice addresses (Care Compare)

609 4J Court
Gillette, WY 82716-4127
Phone (307) 682-2020

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery30

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
408TWYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Gillette Optometric Clinic PC Optometrist CurrentSince Oct 5, 2016 Accepting new patients

Locations

609 Four-J Ct
Gillette, WY 82716
Phone (307) 682-2020

Interoperability endpoints

  • Direct secure messaging: myounger@gilletteoptometricclinic.eyefinity-direct.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1254873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485302400000",
    "number": "1770818858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 4J CT",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827164135",
            "telephone_number": "307-682-2020",
            "fax_number": "307-682-5656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 4J CT",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827164135",
            "telephone_number": "307-682-2020",
            "fax_number": "307-682-5656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNGER",
        "first_name": "MELISSA",
        "middle_name": "MARIE SERREYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-07",
        "last_updated": "2017-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WY",
            "license": "408T",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3270",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gillette, WY

Sources for this page

Verify at the official NPI Registry.