Provider Demographics
NPI:1053428979
Name:YOUNGMAN, LORI A (OD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:YOUNGMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2045
Mailing Address - Country:US
Mailing Address - Phone:315-343-2020
Mailing Address - Fax:315-207-2001
Practice Address - Street 1:147 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2045
Practice Address - Country:US
Practice Address - Phone:315-343-2020
Practice Address - Fax:315-207-2001
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007521-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA410045035OtherRAILROAD MEDICARE
WA410028898OtherRAILROAD MEDICARE
WA410032420OtherRAILROAD MEDICARE
ID410045497OtherRAILROAD MEDICARE
WA410032420OtherRAILROAD MEDICARE
U57223Medicare UPIN
WAG319209213Medicare PIN
ID410045497OtherRAILROAD MEDICARE
ORR041WFBNKCMedicare PIN
ID1593773Medicare PIN
WA410028898OtherRAILROAD MEDICARE
WAG001056824Medicare PIN
WAG000355081Medicare PIN