Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5282 | MA |
NPI | 1003336645 |
---|---|
Provider Name | Dr. Benjamin Young |
First Address | Roslindale, MA 02131-1733 |
Second Address | Roslindale, MA 02131-1733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2017 |
Last Update Date | 07/12/2021 |