Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 1625 | SC |
Y | 152W00000X | Optometrist | 5593 T2507 | OH |
NPI | 1003988197 |
---|---|
Provider Name | Dr. Wayne Matthew Young |
First Address | Chillicothe, OH 45601-1852 |
Second Address | Chillicothe, OH 45601-1852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 29/12/2020 |