Provider Demographics
NPI:1114092418
Name:CHOI, JAMES C (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:CHOI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 HEMPSTEAD TPKE
Mailing Address - Street 2:DAVIS VISION
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1711
Mailing Address - Country:US
Mailing Address - Phone:516-489-7979
Mailing Address - Fax:516-794-1780
Practice Address - Street 1:2921 ERIE BLVD E
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1430
Practice Address - Country:US
Practice Address - Phone:315-446-3145
Practice Address - Fax:315-445-7675
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006372-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU95775Medicare UPIN
NYC263F1Medicare ID - Type UnspecifiedMEDICARE NUMBER