Active NPI
Beverly Young, O.D.
- Optometrist
- Newark, CA
National Provider Identifier
1962545194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 9185
- Practice address
- 1138 Newpark Mall
Newark, CA 94560-5246 - Phone
- (510) 790-1001
- Fax
- (510) 790-1704
- NPI assigned
- Feb 15, 2007
- Sex
- Female
- 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 | 9185 | CA | Primary |
Addresses
Primary practice location
1138 Newpark Mall
Newark, CA 94560-5246
Mailing address
201 E Grant Line Rd
#14
Tracy, CA 95376-2763
Phone (209) 832-7839
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9185 | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Visioncare of California | Optometrist | Past | Accepting new patients |
| Visioncare of California | Optometrist | Past | Accepting new patients |
Organizations & group practices 2
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": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298592000000",
"number": "1962545194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 E GRANT LINE RD",
"address_2": "#14",
"city": "TRACY",
"state": "CA",
"postal_code": "953762763",
"telephone_number": "209-832-7839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1138 NEWPARK MALL",
"city": "NEWARK",
"state": "CA",
"postal_code": "945605246",
"telephone_number": "510-790-1001",
"fax_number": "510-790-1704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "BEVERLY",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-15",
"last_updated": "2011-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "9185",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 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.