Provider Demographics
NPI:1003917469
Name:CHOI AND BANG OD, PC
Entity Type:Organization
Organization Name:CHOI AND BANG OD, PC
Other - Org Name:EYEXAM OF PEACHTREE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-803-1100
Mailing Address - Street 1:2451 CUMBERLAND PKWY SE STE 3860
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6136
Mailing Address - Country:US
Mailing Address - Phone:404-803-1100
Mailing Address - Fax:770-438-5033
Practice Address - Street 1:407 CITY CIR STE 1600
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269
Practice Address - Country:US
Practice Address - Phone:770-487-8013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2019152WC0802X
GA2015152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV00536Medicare UPIN
GAV00535Medicare UPIN
GA6535Medicare PIN